Application for Cosmic DNA Program
Please fill out the application form carefully and completely.
Want to watch the Cosmic DNA video?
Time commitment: 4:34
Personal Information
Full Name
*
First Name
Last Name
Best E-mail
*
example@example.com
Age
*
Getting To Know You.
Let me know a little about you.
Is there any health issue you are currently struggling with.
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Are you currently under the care of a physician? If yes, for what?
*
Do you currently take supplements?
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What are your biggest struggles currently?
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What do you feel has held you back the most in life?
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Describe what good health looks like to you.
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On a scale of 1 to 10 with 10 being perfect, what number is your well-being right now?
*
Why Cosmic DNA?
Have you had your DNA tested before? If yes, from where?
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What was your experience with the results?
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Are you afraid to find out anything with DNA/genetics?
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Yes
No
Why are you applying for the Cosmic DNA program?
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What do you expect to get out of your Comic DNA information?
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Just A Little Bit More...
I understand this is a process and I will have to do the work in order to get the results.
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Yes
No
I understand that this program is designed to support my lifestyle and choices. The program does not address medical issues or conditions.
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Yes
No
I understand that the cost of the Signature Cosmic DNA program is in the high 4 figures and is designed only for people that are serious about getting on the other side of struggle.
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Yes
No
I am ready to get started now.
*
Yes
No
Book your Zoom Meeting to see if Cosmic DNA is right for you!
Click the calendar image to be taken to the current booking calendar. Make sure all fields in this survey are filled out completely first.
Once your appointment is scheduled, look for an email from us.
If you need anything, you can reach out to kelly@genomicmystic.com
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