Full Name
Date of birth
Address
First, tell us a bit about yourself. Where do you live, what do you do, whether you have partner or kids, etc. (A few sentences or bullet points please.)
What is your diagnosis and when were you first diagnosed? What's going on now?
What is your biggest cancer related struggle right now?
How did you first hear about Dr. Lori (ND)'s approach to healing ? What made you interested in applying?
On a scale from 1-5 (5 being the highest) how ready are you to make a change to your lifestyle (eating, exercise) in order to reach your goals?
1
2
3
4
5
No elements found. Consider changing the search query.
List is empty.
Why is now the right time to invest in yourself and take action? Why not six months ago or six months from now?
Why is now the right time for you to invest in your healing and how committed are you to achieving your goals? NOTE: There are several ways to work with me, and my team. Cost can range from $1,200-10,000 USD
I am fully committed - I have the resources to invest $10k USD in my health to make this happen
I am fully committed - I would have difficulty coming up with $10K USD to invest in my health at this time
I am committed - My financial position would be a better fit for an Medical Review & Guided Option at $1200 USD
I am pretty committed but I'm not really sure I'm ready to prioritize my healing yet
I am not committed at all
Anything else you would like to add?
SUBMIT
