First Name
Email
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Phone
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UTM Source
UTM campaign
UTM medium
Have you been formally diagnosed with rheumatoid arthritis? (You do not need a formal diagnosis to work with me)
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Describe your current level of rheumatoid arthritis symptoms
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Which of the following medications are you currently taking to manage your rheumatoid arthritis symptoms? (select all that apply)
I’m not currently taking any medications to manage my RA symptoms
Conventional DMARDs — Methotrexate, Hydroxychloroquine (Plaquenil), Sulfasalazine, Leflunomide (Arava)
Biologics — Humira, Enbrel, Orencia, Actemra, Remicade, Simponi, Rituxan/Rituximab
JAK inhibitors — Rinvoq, Xeljanz, Olumiant
Steroids — Prednisone/Prednisolone, Methylprednisolone, steroid injections
NSAIDs / anti-inflammatory painkillers — Ibuprofen, Naproxen, Celebrex/Celecoxib, Diclofenac, Meloxicam
Other painkillers — Tylenol/Paracetamol/Acetaminophen, Tramadol, other prescription painkillers
Outside of seeing a doctor or rheumatologist, how much effort have you personally put into trying to improve your rheumatoid arthritis symptoms?
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When it comes to investing in improving your health, which best describes your current situation?
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If we decide to work together after the call, when would you like to get started?
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SUBMIT