Root Cause Health Survey

A short survey to better understand what adults in our community are experiencing with weight, inflammation, energy, digestion, and labs. Takes about 2 minutes.

First Name *

Last Name *

Email *

Phone (Optional)

Service Text Consent:

By checking this box, I consent to receive non-marketing text messages from Pure Hope Weight Loss and Healthcare about appointment reminders, scheduling updates, account notifications, lab kit reminders, and other service-related communications. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out

Marketing Consent:

By checking this box, I consent to receive marketing and promotional messages, including newsletters, educational health tips, event invitations, special offers, program updates, and other practice updates, from Pure Hope Weight Loss and Healthcare at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

What feels the most frustrating right now? Select all that apply.

I am doing the right things but not seeing results

My labs are changing and I do not know why

I feel inflamed, tired, or uncomfortable in my body

I feel like no one is connecting the dots

I do not know where to start

Other

If other, please explain:

How much does this resonate with you? "You are not broken. You are just missing answers."

Very much

Somewhat

Not sure yet

How interested are you in a root cause program that includes advanced lab testing, personalized protocols, and supportive coaching?

Very interested

Somewhat interested

Not sure yet

Not interested

What would you like to do next?

Book a free 15-Minute Body Reset Call

Learn more by email first

Attend a free workshop

I am not ready yet

This survey is for educational purposes only and does not create a patient-provider relationship. Please do not submit urgent medical concerns. HIPAA forms are provided during patient intake.
By submitting this form, you agree to our Privacy Policy, Terms & Conditions, and SMS Terms.