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Which of the following are you experiencing regularly? *

High Blood Pressure or BP Spikes

Health Anxiety or Cardiophobia

Chest Pain or Tightness

Heart Palpitations or Irregularities

I feel like my symptoms are: (Pick One) *

Caused primarily by physical factors

Caused primarily by mental or psychological factors

Both are major factors

How long have you had your symptoms? *

2 months or less

3 months - 12 months

1 - 2 years

3 years +

As long as I can remember

On a scale of 1-5 how much do your symptoms and health get in the way of your life? *

1 (Minor inconvenience)

2

3

4

5 (Life-disrupting)

Which of the following have you tried to gain relief? *

Seeing my doctor

Basic lab work

Medications

Talk therapy

Lifestyle changes

Advanced or specialty lab tests

Functional medicine

Which of the following most aligns with your health improvement goals? *

I want peace of mind and control over my health

I want to perform better at work (more energy, focus)

I want to enjoy time with family and friends worry-free

I want to do activities (exercise, travel, hobbies) without fear

Our lab tests and functional medicine services are not covered by insurance (HSA/FSA accepted). Would you have at least $1000 available to invest in your health? *

Yes, if I felt confident

Not at this time

What would you like to gain from a free session with us? *

Understand the biomarkers behind my symptoms

Get a personalized treatment plan created

Learn more about your programs and approach

Learn specific techniques for instant relief

Full Name *

Phone *

Email *

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