Westport Medical and Wellness Center What Are Your Interests? Question Title * 1. Which of the follow would be of interest to you? Please check all that apply Yoga Tai Chi Meditation Breathing exercises Facials Botox Fillers Acupuncture Other (please specify) Question Title * 2. Which style of coaching would you prefer? Please check all that apply Lifestyle Coach Health Coach Other (please specify) None of the above Question Title * 3. Are you interested in seeing a Nutritionist? Yes No Question Title * 4. Are you interested in Massage Therapy? Yes No Question Title * 5. Which other specialty would you like to have available at the wellness center? Please check all that apply Cardiology Endocrinology Weight Loss Medicine Sex Therapy Psychiatrist Other (please specify) Question Title * 6. What percentage of your peers do you feel would be hindered by a $1,000 yearly fee or $100 per month?*Please note this is not a concierge fee, but an administrative fee for services not covered by insurance* 10% 15% 25% 50% 75% 100% Why? Done