Is Nutritional Therapy Right for Me?

Name:
Are you wanting to take your health journey to a new level?
Yes
No
On a scale of 1 -10 how would you rate your health?
1
2
3
4
5
6
7
8
9
10
Which of these statements are true for you? (Select all that apply)
I want to feel better naturally
I like to take vitamins every day
I only take medicine if I get sick
I do not like going to the doctor
I have never tried vitamin infusions
My doctor told me I was fine but I don't feel as good as I used to
I try to remember to take my vitamins everyday
I hate taking pills
None of thee above
Which symptoms are you seeking help for?
Fatigue/Energy
Brain Fog
Weight Support
Difficulty Sleeping
Detox
Immune Boosting
Headaches
Joint/Muscle Aches or Pain
Depression/Anxiety
Athletic Performance
Overall Health
Other
None of thee above
Do you struggle from the following?
Anemia
Dehydration
Gastric Bypass
Slow recovery after work outs
High Blood Pressure
Inflammation
Other
None of thee above
Do you hate the idea of needles?
Yes
No
Have you ever been to Intentions Health and Wellness Studio Before?
Yes
No
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