You can always press Enter⏎ to continue
Thanks for showing an interest in The Daoland Health Builder. Just answer a few short questions to apply...

Thanks for showing an interest in The Daoland Health Builder. Just answer a few short questions to apply...

Please be as complete as possible so that we are both well prepared when we talk.  Let's both get as much out of this to see if the program is what you need and want!
11Questions
  • 1
    This way I know who I am talking to,
    Press
    Enter
  • 2
    Press
    Enter
  • 3
    Press
    Enter
  • 4
    Press
    Enter
  • 5
    Your choice is not a permanent choice, in our conversation you come to learn about what you need and want.
    Press
    Enter
  • 6
    What do you think the Daoland fasttrack program can help you with in the above fields?
    Press
    Enter
  • 7
    What aspects of your personality, health or life environment are holding you back to fulfill your expectations and needs?
    Press
    Enter
  • 8
    You might be busy with improving your life for some time, but understanding the need to change is a great help in actuall change.
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    Press
    Enter
  • 9
    These options are currently active in the app. Please make a preselection of what programs seem interesting to you. This selection is a lead for our talk on what you need. It might also be something not there!
    Press
    Enter
  • 10
    There is no need to fill anything here. This widget is to warn me when your submission is made so i can react asap
    Press
    Enter
  • 11
    I need your consent to call you or email you to talk about your choices. I Aim to contact you persoanlly within the shortest time possible when you send in the form. If you concent below with a yes, also please ad what medium you like me to contact you,
    Press
    Enter
  • 12
    -
    Pick a Date
    Press
    Enter
  • Should be Empty:
Question Label
1 of 12See AllGo Back
close