Live Vitae | Health and Energy Optimization Assessment

1
What is your first name?* This field is required.
2
and your last name?* This field is required.
3
Phone number (mobile/ whatsapp)?* This field is required.
Country Code
Area Code
Phone Number
4
Please confirm your email address* This field is required.
example@example.com
5
What health issues do you suspect or have received a medical diagnosis for (e.g., Hashimoto's, Long COVID, Chronic Fatigue Syndrome)?* This field is required.
6
Please give details about what you have you tried up to this point to fix your health issues? e.g. Protocols, Supplements, Medications etc.* This field is required.
7
How long have you been dealing with these health issues?* This field is required.
<6mo
6-12mo
1-3yr
3+yr
8
What you would like to achieve by working with Ryan in the next 6 months?* This field is required.
9
This is a dedicated 6-month biological and lifestyle restructuring. Are you prepared to commit to this timeframe in order to transform your health?* This field is required.
Yes, I am 100% committed to a 6-month biological transformation
No, I am looking for a quick fix or short-term protocol
10
Working with Ryan for 6 months ranges from £2,400-6800, depending on the exact program. Can you confirm you are aware of this and ready to invest in your health? * This field is required.
Yes, I am ready to invest within this range to resolve my health.
I am serious, and I would want to discuss payment options.
Not something I can put toward my health right now.
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