Application to Work With Dr. Seamus

Name

First Name Last Name

E-mail

example@example.com

Birthdate

Gender

Occupation

Phone Number

How did you hear of Emunah Health LLC? If a specific person referred you, please include their name.

Emunah Health LLC is a top-tier concierge, telehealth service to decipher the root cause of chronic diseases and illnesses. Through a health history intake form discussion, lab work, dietary and lifestyle modifications and specific supplemental regimens, we go up-stream to tackle disease processes at their source. This can ensure the full scope of the problem is eradicated and recurrence rates are virtually non-existent. Dr. Seamus is passionate and excited to work with you to put your chronic diseases into remission so you can enjoy an elevated quality of life.

What are your top health goals in the next 6 months? Be specific.

What do you see as the biggest struggle to reaching those goals?

Who or what in your life has been negatively impacted as a result of your current health status?

What are you most excited about unfolding in your life 6 months from now if you're looking and feeling your best?

Are there other goals you'd like to accomplish in the next 6 months not directly pertaining to health?

At Emunah Health LLC, functional medicine lab testing is a key component to objectively determining what's going on in each patient's body. This can help tailor-make an approach specific to each person that will directly help their body overcome various ailments. Most kits can be delivered right to your doorstep and can be done in the comfort of your home. Are you willing to have lab work done to assess: levels of inflammation in the body, nutritional status, immune functionality, presence of parasites, heavy metal burdens, yeast overgrowth, etc.?

Is there anything else you'd like Dr. Seamus to know?

Dr. Seamus has various offerings.

-       His 21-day purification/detoxification program costs $265.50-275.50.
-       His monthly maintenance package (multivitamin/mineral, essential fatty acids like omega 3 and probiotic) costs $115.
-       The price of just lab work, (adrenal stress index, GI Map and Organic Acids Test) which covers the 3 major body systems – neuroendocrine, gastrointestinal and detoxification costs $995. Zoom report of findings with Dr. Seamus is included.

- Blood work with LabCorp - Complete Blood Count (CBC) with Differential and Platelet Count and Comprehensive Metabolic Panel (CMP 14) with a Zoom report of findings with Dr. Seamus costs $150.

- His one-on-one 6 month health transformation program (review of health history intake form, ordering and going over 1 lab test, supplying specific dietary protocol sheets, all supplements, once per month Zoom sessions with additional text access, lifestyle modification principles and follow-up lab work) costs $3,960.
- His one-on-one 6 month health transformation program (review of health history intake form, ordering and going over the 3 MAJOR BODY SYSTEMS lab work, supplying specific dietary protocol sheets, all supplements, once per month Zoom sessions with additional text access, lifestyle modification principles and follow-up lab work) costs $5,260.

Are you willing and ready to make one of those investments into your health right now?

Yes No

Signature

Clear

Signature Date

Date

Application to Work With Dr. Seamus Allen