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CONTACT ME FOR A FREE 30 MINUTE CONSULTATION
Please fill out the questionnaire below and I will get back to you.
Name
DOB
Email
What is your main health complaint?
How often does it bother you?
How long has it been going on?
What (or who) would prevent you from completing a health-rebuilding program?
What is your current diet like? Please be specific: list breakfast, lunch, dinner, and snacks as while as times you eat
Are you taking any supplements or medications? Please list what you take and what it is for.
What would you like your health to be 3 months from now? 6 months from now?
What obstacles, challenges, and struggles do you face regarding diet/lifestyle?
If we were to work together, what would you expect to achieve?
What are 5 things you LOVE about your life?
Thank you for contacting us.
We will get back to you as soon as possible
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WHERE TO FIND ME
CONTACT
phone: 630-291-5108
email: abetterwayholistics@gmail.com
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