Comprehensive Visit Application
This form is designed to give us insight into your current life situation and your perspective on wellbeing. We will reach out to you within the next 48 hours to schedule a connection call. There are no "right" or "wrong" answers, only what is true to you!
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
What country do you live in?
How open are you to making changes in your life?
I am all in
Not sure
Not at all
I do not need to change anything
How would you describe your overall health?
I am generally healthy
Sometimes I have symptoms
I feel unwell often
Do you trust your body?
Yes
Sometimes
No
What's your current healthcare mindset?
I rely on my conventional doctor/specialist
I rely on my holistic practitioner/guru
I follow advice online/ podcasts/ programmes etc.
I trust myself and my body
Do you recognise any limiting beliefs that might be holding you back from reaching your goals and dreams?
Please Select
Yes
No
Not sure
On a scale of 1-5 (5 being the highest), how willing and committed are you to invest in doing what it takes to create your dreams and goals authentically?
Please Select
1
2
3
4
5
By submitting this application, I would like to apply for the Comprehensive Visit. I promise that I am committed to doing everything necessary to achieve 100% from this life-changing process.
Submit
Should be Empty: