Tailor Your Consultation Experience

Help us understand your goals and background better.

Complete this quick survey to make the most of your upcoming consultation.

Let's Start With Some Basic Info

Email *

Phone *

Full Name *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Now, Let's Dive Into Your Practice

How long have you been practicing medicine? *

Describe your practice; what do you do, who do you see? *

What is your favorite thing about medicine? (This is between us, so please save the happy clappy answer. I want to know what you really love about what you do.) *

What do you hate about what you do? What is the thorn in your side? *

Can you describe the way you would spend your perfect day? *

What areas of healthcare interest you the most? *

What are the last 3 books you read? *

How do you stay current in the healthcare space? *

Do you belong to any organizations or other masterminds? *

Yes

No

Do you attend seminars regularly? What are the last few? *

Enough With Business, That Is The Fruit. I Want To Dig Deeper Into The Roots Now.

Are you married? How would you rate your marriage 1 -10? *

What is your favorite thing about your spouse? *

What bugs you about them the most? *

Do you have scheduled date nights? *

Yes

No

Do you have scheduled trips or little getaways? *

Yes

No

Do you have kids? *

Yes

No

If so, what are their ages? *

Are you involved in their activities? *

Yes

No

How often do you do family vacations? *

How often do you go solo with your spouse on vacations? *

Let's Dive Into You. I Want To Know About Your Personal Health, Mental Health And Discipline.

How old are you? *

When was the last time you had a detailed lab panel completed? *

Do you have any current health challenges? *

When were you in your best health? *

Do you exercise regularly? *

Yes

No

What does your weekly workout commitment look like? *

What does your daily food intake look like? *

What area do you feel is your weakest area in your health? *

What do you do about stress? *

Do you meditate? *

Yes

No

How do you view the world beyond yourself, beyond your family? This can be the heaviest part: *

Let's Dive In, Please Get Deep And Clear With Me:

Where do you stand spiritually? *

Were you raised religiously? *

Yes

No

Would you consider yourself religious? *

Yes

No

Do you have a specific religion you identify with? *

Tell me about your relationship with a higher power? *

How do you feel about where you are with your well-being? *

How much does your spiritual connection affect your day to day? *

Do you wish your relationship was better with that higher power? *

Yes

No

Thank You for Sharing Your Journey

We deeply appreciate the time and thoughtfulness you've put into completing this survey. Your responses are invaluable in helping us understand your unique experiences and aspirations, both professionally and personally. This detailed insight is crucial in tailoring our approach to meet your specific needs and goals.

Remember, this journey is about unlocking your full potential in every aspect of life – from your medical practice to your personal well-being. The information you've shared forms the foundation of a transformative path we'll embark on together.

If you have any additional thoughts or information you'd like to share, please feel free to reach out. We're here to listen and support you every step of the way.

Thank you once again for your openness and trust. We look forward to working closely with you and witnessing the incredible growth and achievements that lie ahead.

Best regards,

The One Percent Life Team

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Tailor Your Consultation Experience

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