Exit Integrative Health Intake Questionnaire Question Title * 1. How ready, willing and able are you to commit to improving your health or performance on a scale of 1-10? Less than 5 6 7 8 9 10 Question Title * 2. What would you like to improve upon or achieve during our 90-day program? Select all answers that apply. Lose body fat Get rid of joint pain or nagging injury Improve athletic performance and speed up recovery Increase general fitness to enjoy a long life Increase lean muscle mass Learn about Nutrition and supplementation Get off of prescription medications Find a treatment alternative to an ailment that doctor's may have told you are not treatable Look and feel younger Guidance when the 90 day program ends for further support Other (please specify) Question Title * 3. Which Services would best suit your needs? Select all that apply. Photobiomodulation Treatment Nutrition and supplementation system At home Yoga, Meditation and Fitness subscription In-clinic accountability support All of the above Other (please specify) Question Title * 4. Would you like to schedule a free consultation with our service providers to determine what treatment plan will best suit your needs? Select all that apply. Photobiomodulation In-Clinic Consultation Nutrition & Supplementation consultation Fitness Consultation Question Title * 5. Please enter your contact information so we can reach out to you. Name City/Town Email Address Phone Number Done