First Name
Last Name
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What health concern(s) would you like to discuss during your consultation?
How long have you been dealing with this issue?
Less than a month
1–6 months
Over 6 months
Years
Which of the following best describes your concern? (Choose the one that fits best)
Pain or injury
Hormonal or Thyroid Issues
Gut or digestive problems
Fatigue or low energy
Mental or emotional health
Weight or metabolism
Not sure / want a general consultation
Cancer support
Preferred day/time for your consultation?
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Evenings
Any Time Works
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