Nice work! By taking this survey, you're already taking the first step towards improving your health. Your answers will help make your Health Assessment with Dr. Stanislaw tailored to your specific needs and questions. There are 9 questions.

* 1. Please list YOUR FULL NAME, EMAIL & PHONE # in the box below. WITHOUT THIS INFO, WE WILL NOT BE ABLE TO CONTACT YOU. Also, please list how your heard about Dr. Jody.

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