Your Name*

Your Email*

Your Phone Number*

If you were to set priorities now, what three health issues would you like to resolve?*

How important is achieving this to you?*

1 being not very, 10 being it is one of the most important things to you right now.
12345678910

How motivated are you to achieve this?*

1 being not very, 10 being the most motivated you have ever been.
12345678910

What is your current state of health costing you now?*

(not just financially, but in relationships, happiness, etc)

Having resolved these health issues, what would the impact of this be on your life?*

(Relationships, finances, energy levels, happiness, fitness etc)

What are you willing to invest to achieve this, right now?*

---£500£500 - £1000£1k - £3k£3k +

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