Apply – Heart Heath Tips

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Please fill out the form below so we can prepare for your appointment.

Name*
First Last
Email*
Please use the same as you gave for the appointment booking
Confirm your phone number*
What is your current occupation?*
Briefly describe your current health condition*
What is your biggest struggle when it comes to dealing with your heart disease?*
Have you tried anything in the past (or recently) to eliminate your heart disease symptoms? If so, what?*
Which of those things worked well for you, and why?*
Which of those things didn’t work well for you, and why not?*
Until now, what has blocked you or held you back from changing these things?*
Finish this statement below:*
If someone advised me to change my eating habits and adjust my lifestyle I would…
- Know it’s what any serious person needs to do to achieve optimal health.
- Would be a little intimidated, yet with a proven, easy to follow system I would do it because I’m serious about my health.
- Avoid it at all costs because I want to eat whatever I want.
Do you promise to show up for your scheduled appointment ON TIME and DISTRACTION FREE?*
Please confirm by typing, “Yes I will” in the box below.