15 Min Call | Your Nutrition Physicians

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OUR CLINIC

First Name

Last Name

Phone

Your Age

Describe in detail the health challenges you are currently facing.

How long have you been dealing with these symptoms that are causing you problems?

What have you tried to improve your health? (Check all that apply): * Required

Prescription Medications

Over- the- counter Supplements

Special Diets (keto

Excercise & Movement Plans

Detoxes & Cleanes

Functional medicine or holistic care

Nothing yet- I'm just getting started

Other

What are your health goals? (Check all that apply): * Required

Increase energy & motivation

Increase energy & improve digestion

Sleep through the night

Lose weight in a healthy

Balance my hormones naturally

Reduce inflammation and pain

Get off medications (with doctors supervision)

Live a long

Live long & die short

Other

How motivated are you to take the next step to heal the root cause of your symptoms?

What’s stopping you from getting the results you want right now? (Check all that apply) * Required

I don't know what's really causing my symptoms

I've tried things before that didn't work

I'm overwhelemed and don't know where to start

I'm scared I'll fail again

I'm worried about the cost

I'm not sure I have the support I need

Other

Have you worked with a functional natural medicine doctor before?

What would success look like for you in the next 6–12 months? If YOU felt better, YOU'D be able to...................

If we both realize that we're a good fit for each, how soon would you be ready to begin?

Why do you believe working with a functional natural doctor is the right next step for you right now? (Open-ended)

Are you in a position to financially invest in your health?

Is there anything else you’d like to share with us about your health journey? Something not mentioned above.

Now it’s time to schedule your free 15-minute consultation. Explore whether our program is the right fit for you. 🗓

You have much to gain by talking with us. Even one conversation could be the beginning of a completely new chapter in your health.

Thanks for submitting!

+1 (954) 436-6161

info@yournutritionphysicians.com

USA

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