Tailor Your Consultation Experience

Help us understand your goals and background better.

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

Full Name *

Email *

Phone *

How long have you been practicing medicine? *

Describe how you practice: *

Solo Provider/Practice

Group Practice/Partner

Chiropractic Practice

Functional Practice

If other selected, please describe how you practice below. *

What Is Your Annual Income? *

What is your ideal annual income? *

How many hours a week do you work? *

How do you rate your focus on family time? - 1 to 10? 10 being great *

What do you want more of in your family life? *

How do you rate your focus on your health? - 1 to 10? 10 being great *

What do you want to see improved in your health? *

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