Are You A Fit For Functional Medicine 1. How ready are you to commit to a lifestyle change to better your health?*0 - Not Ready1 - Always wanted to but haven’t got around to it2 - Thinking about it3 - Open-minded to listen4 - Motivated to take action5 - Let’s do it!2. How good are you at committing to your health?*0 - I'm Not1 - I take better care of everyone/everything else2 - I’m aware I need to do something3 - I am ready to do better4 - Motivated to take put me first5 - I do a good job already3. Do you like the idea of learning about the 6 modifiable factors of Lifelong health and how they play a role in your life?* Yes No 4. Do you currently practice self-care?* Yes No Sometimes 5. How Resilient (adaptable to the moment or world around you) would you rate yourself?*0 - I struggle with most all significant challenges that presents to me1- I try to roll-with-the punches, but have setbacks2 - I do pretty good with most small changes3 - I adapt well to every challenge 6. How many years have you been struggling with Poor health?*1-2 Years2-4 Years5-10 Years11-20 YearsFor as long as I can remember7. Do you find Joy and happiness within you?* Yes No Sometimes 8. Do you have a family history of chronic disease (Anxiety, depression, autoimmune conditions, diabetes, infertility issues, Leaky gut, heart disease, stroke-susceptibility, fatty liver, unmanaged/uncontrolled Thyroid issues, advance Brain-Cognitive disease (Alzheimer’s, Multiple Sclerosis, Parkinson’s, Autism spectrum, wired-and-tired)?* Yes No Unsure 9. How Sick and Tired are you, from feeling Sick and Tired?* 9. I’m Sick, tired, and ready to get my health back I’m doing just great! Enter Your Information For ResultsName* First Last Email* Phone*
