Full Name

1
Do you suffer from any of these illnesses - M.E/CFS, Long Covid, POTS, Fibromyalgia or Post Viral Fatigue* This field is required.
Yes
No
2
What are you suffering with?* This field is required.
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Please Select
Chronic Fatigue Syndrome
Long Covid
POTS
Post Viral Fatigue
Fibromyalgia
All of the above
3
Which of these have you tried already?* This field is required.
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Brain retraining
Supplements / Medication
Doctors and medical route
Alternative therapies
All of the above
4
Before you got sick, briefly describe your typical daily activities and energy levels* This field is required.
5
Please specifically list 3 things that you need help with for your recovery right now?* This field is required.
6
If we helped you over the next six to twelve months to improve your health and wellbeing, what are three goals you would love to be able to achieve in that time?* This field is required.
7
On a scale of 1–10. 1 being low and 10 being very high, how committed are you to improving your health right now?
8
We believe that a holistic integrative approach is required to achieve results and recovery. Quality sleep, routine & structure, baseline, nutrition, mindset, progression and self responsibility all play a role. With the right help, tools, frameworks and education, are you committed to working on different areas of your health and well-being to obtain the results you want?* This field is required.
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Please Select
Yes
No
9
Is this an important enough priority that you can allocate (or find) the financial resources toward a solution if you knew it would help you get better?* This field is required.
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A. I’m not in a position where I can spend anything on my health.
B. If this is the right fit for me, I am able to invest $159 per week in my health for my recovery
10
Would you like someone else to join you on this call? If there's someone you'd like to have with you for support in making the best decision, please share their name below.
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Please Select
YES
NO
11
What is your full name?* This field is required.
First Name
Last Name
12
Age* This field is required.
13
Email* This field is required.(You are one step away from getting your recovery plan call)
example@example.com
14
Country Code & Mobile Number
Should be Empty: