First Name *

Last Name *

Email *

Phone *

What were your original health goals when you joined our program? *

General Wellness Checkup

Improve energy, mood, and mental acuity

Achieve fitness / weight gain or weight loss goals

Prevent or correct chronic illness

Enhance sexual health

Balance hormone health

Learn more about longevity and regenerative options

Discuss the latest biohacking methods

Other

Where have you noticed the most improvement since you started our program? *

In what ways have you improved in that area?

If you were grading yourself A through F how would you grade yourself in these areas in the last few months? (standard academic grading scale, A+ being the best, F being failing)

Sleep *

Nutrition *

Exercise *

Energy *

Libido *

Following your treatment plan *

Stress Management *

Do you feel like you have a clear understanding of your treatment plan? *

yes

Is there anything that has been holding you back from excelling in the above fields? *

Are there any specific questions you would like answered during your consultation? *

Since you have begun treatment with us, are there any new goals that have come up for you? *

What has been the most outstanding part of your experience with us so far? *

In what ways can we serve you better? *

What other services are you interested in learning about? *

What other services are you interested in learning about?

Hormone Therapy
Peptide Therapy
Weight Loss
General Health Optimization
Gut Health
Regenerative Medicine (PRP / Exosomes)
Mold Toxicity
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Is there anything else you would like to know during your following consultation with our team?

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