This is not a form. It is a conversation — the one I wish every physician had with you before you walked through their door. Your answers will shape everything about our time together and the program I am designing for you. Please be honest. There are no wrong answers here.
◆ About 10 Minutes ◆ Completely Confidential ◆ Read Personally by Dr. Pete
QUESTION 01 | SINGLE BIGGEST STRUGGLE
QUESTION 02 | BUCKET — LIFE STAGE
QUESTION 03 | BUCKET — PRIMARY PAIN CATEGORY
QUESTION 04 | BUCKET — READINESS
QUESTION 05 | DEEP DIVE — SYMPTOMS
QUESTION 06 | DEEP DIVE — DURATION
QUESTION 07 | DEEP DIVE — IMPACT
QUESTION 08 | DEEP DIVE — PREVIOUS CARE
QUESTION 09 | DEEP DIVE — THE MEDICAL EXPERIENCE
QUESTION 10 | ASPIRATION — OPEN
QUESTION 11 | ASPIRATION — PRIORITY RANKING
Rank these outcomes from most to least important to you personally. Your #1 becomes the north star of your program design.
QUESTION 12 | ASPIRATION — THE COST OF INACTION
QUESTION 13 | PROGRAM DESIGN
QUESTION 14 | ACCESS PREFERENCE
QUESTION 15 | FORMAT PREFERENCE
QUESTION 16 | THE PIVOT — HESITATIONS
QUESTION 17 | THE PIVOT — THE REAL OBJECTION
QUESTION 18 | CLOSING OPEN
Your answers go directly and only to Dr. Marta. They are held in complete confidence and read personally before our time together.