NEW CLIENT CONSULTATION FORM

FREE DISCOVERY CALL INTAKE - DYNAMIC WELLNESS
Welcome! Briefly answer the questions posed below. If you are looking for a health check-up, only respond to the applicable questions.
In our Zoom call, I will share a little bit about me and how I work. Then we will address the questions below so that I can learn some more about your specific health concerns. Finally, we can talk about pricing and which program to run, so that you can decide at your own pace if we are a good match. There is no pressure to work with me, as I strongly believe in the importance of finding a good fit to bring forth healing.
What made you decide to seek out help now?
What is your main complaint?
How often does it bother you?
How long has it been going on, when was the starting point, and what happened at that moment?
What have you tried so far that hasn’t worked?
What have you tried that has helped?
How does it affect your life or what does it prevent you from doing?
Who or what may stop you from completing a health rebuilding program?
Who else in your life would benefit from your healing journey?
Who do you live with?
Are you currently on any medications and if so which ones?
Do you eat meat?
What would you expect to achieve working with me? What would success look like?
On a scale of 1-10, how committed are you?
(10 being most committed)
Thank you very much for taking the time to fill out the form. After submitting the form you will be redirected to a calendar. Please go ahead and book a 20 min free discovery call with Dynamic Wellness. We are looking forward to meeting you and supporting your health goals.

www.marlenbrauns.com

Personal information is ONLY gathered for the sake of ordering lab work (no marketing). If we decide we are not a good fit, all this information will be destroyed instantly. Until then it will be kept private and confidential.
Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Gender*

FemaleMaleOther
Occupation*
Should be Empty:

FREE DISCOVERY CALL INTAKE - DYNAMIC WELLNESS

Welcome! Briefly answer the questions posed below. If you are looking for a health check-up, only respond to the applicable questions.

Thank you very much for taking the time to fill out the form. After submitting the form you will be redirected to a calendar. Please go ahead and book a 20 min free discovery call with Dynamic Wellness. We are looking forward to meeting you and supporting your health goals.

Personal information is ONLY gathered for the sake of ordering lab work (no marketing). If we decide we are not a good fit, all this information will be destroyed instantly. Until then it will be kept private and confidential.