Discovery Call Application Form

Gather a prospective client's health goals, background, and availability before booking a discovery call, so the first conversation starts focused and productive.

Use this template

Welcome

Full Name

Nombre

Apellido

Email

Age

Gender Identity

How did you hear about our practice? If someone referred you, please share their name so we can thank them

What are your top health goals for the next 12 months? Please be as specific as possible

What has been your biggest struggle in reaching those goals?

If you could eliminate 3 health problems holding you back from fully showing up in life, what would they be?

Would you be willing to get specialty lab testing to uncover the root cause of your health issues? (can be done from the comfort of home)

Yes No

On a scale of 1 to 10 (1 being the least, 10 being the most), how motivated are you to solve your health problems?

The investment to work with me varies based on your customized program, with a minimum of $595. Are you ready to commit to your health this way? (health insurance is not accepted)

Yes, I'm ready to commit

I only accept a limited number of new clients per month to provide comprehensive, personalized care. If we decide to work together, when could you start?

I'd like to subscribe to receive functional plant-based medicine tips and updates on future programs

Yes No

Discovery Call Application Form

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