Thriving Health Consultation Interest Questionnaire

Thriving Health Consultation Interest Questionnaire

Kristen Smith, Herbalist & Aromatherapist
Thank you for your interest in a Thriving Health Consultation! Please answer the following questions and I'll get back in touch within 24 hours.
Name

First NameLast Name
Email
example@example.com
Tell me about your health or wellness goal.
Have you seen a doctor or other licensed healthcare provider for this need?

YesNo
If yes, please tell me about any diagnosis you received and any other important information shared.
What consultation level(s) are you most interested in at this time?

Initial Consultation Package ($179)3-Month Consultation Package ($349)6-Month Consultation Package ($599)12-Month Consultation Package ($999)
Do you fall into any of the following categories?

Active duty military or VeteranPastor or Pastor's Wife/ChildFinancial hardship
Please review my Terms of Service and verify that you understand I am not a licensed care provider and cannot diagnose, treat, prevent, or cure disease. Information discussed during our call and shared in a printable summary is for educational use only. You are solely responsible for what you do with that information.
Do you agree to the Terms of Service and understand I am not a licensed health professional and cannot diagnose, treat, prevent, or cure disease?

YesNoI'm not sure
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