Health Challenges Survey

Ask people which conditions affect them today, which remedies they already use and whether they would try a complementary approach. Grids group concerns by body system so patterns are easy to spot. Wellness advisors can then follow up with the right recommendation.

Use this template

If you could change one thing about your health, what would it be?

Full name

Nombre

Apellido

Email

Mobile phone number

Mailing address

Dirección

Ciudad

Estado / Provincia

Código postal

Do you currently use any of these?

Vitamins or supplements Essential oils Chiropractic care Massage therapy Acupuncture Herbal remedies None of these

Is there any reason you would not try a complementary or alternative approach for these concerns?

No, I would be open to it I am concerned about the cost I need more information I prefer conventional medicine only I would need to ask my doctor first

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