Discovery Call Web Form - English

Thank you for your interest in scheduling a Discovery Call with me. I look forward to learning more about you and your health concerns.

Before booking your appointment, please take a few minutes to complete the health questionnaire below. Your answers will help me better understand your symptoms, health history, and goals so that our conversation can be as productive and personalized as possible.

Once you have completed and submitted the questionnaire, you will be directed to the purchase page where you can select a convenient time for your Discovery Call.

I look forward to speaking with you soon.

First Name *
Last Name *

Email *

Phone *

What is your language preference ? *

EnglishGerman

Main health complaint? *

Birthday *

How often does it bother you? *

EverydayOnce per week2 to 3 times per weekOnce per month

How long has it been going on? *

1-6 months1-3 yearsOver 3 years

What (or who) would prevent you from completing a health-rebuilding or weight loss program?

Children

Spouse

Time

Self

Money

Resources

Job

Fear

What have you tried so far that has or has not worked? *

What is your current diet like? Please be specific: list breakfast, lunch, dinner and snacks, as well as the times you eat. *

Are you taking any supplements or medications? Please list what you take and what it's for. *

What would you like your health to be in 3 months from now? How about 6 months from now? *

What obstacles, challenges, and struggles do you face regarding diet/lifestyle? *

If we were to work together what would you expect to achieve from working with me? *

What are 5 things you LOVE about your life? *

What is your current health situation costing you physically, emotionally, or in your daily life — and what do you think may happen if nothing changes over the next few years? *

If your current health patterns continue without meaningful changes, how do you envision your physical, emotional, and overall health in the next 3–5 years? *

Yes! I want to get awesome health tips, tools and resources

Your privacy matters! Your information will be kept private

because that's how it should be :)