Readiness Quiz - website

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Readiness Quiz

Readiness Quiz

Hi there, please complete your details and answer these questions to help us understand your needs.We will then send you some information about the practice.

11Questions

1
Email* This field is required.
example@example.com
2
Your name* This field is required.
First Name
Last Name
3
Phone Number* This field is required.
Area Code
Phone Number
4
Are you willing to complete a detailed history online at your own pace to enable your practitioner to do your Functional Medicine Analysis?* This field is required.
Yes, no problem.
Unsure, I am not confident with computers.
No, I don't have access to the internet. I need a paper based questionnaire.
5
Are you willing to do functional testing at home plus blood testing at the clinic if required? * This field is required.
Yes when provided with video and written instructions.
Yes but I would need further support from a relative.
No I do not want to do testing at home.
6
I am willing to change what I eat in order to improve my health.* This field is required.
7
I am open and willing to adding supplements to my diet to correct deficiencies or imbalances which will assist with improving my health.* This field is required.
8
I would be willing to alter my lifestyle to improve my health e.g. reduce alcohol, learn relaxation techniques etc.* This field is required.
9
I am willing to increase my activity level and do moderate exercise to improve my health.* This field is required.
10
I would accept advice about how to reduce stress in my life.* This field is required.
11
I am willing to spend money on advanced testing, supplements and the clinic's services to improve my health. I am able to invest:* This field is required.
$500-1500
$1500 - 2500
$2500-5000
Whatever it takes
Should be Empty:

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