Discovery Questionnaire

Ready to be made well?

You've already taken the first step by exploring Viriditas Health.

The next step isn't booking an appointment.

It's sharing your story.

Every person's health journey is unique, and I'd love the opportunity to learn more about yours before we meet.

Your story deserves to be heard, and helps me understand:

• where you've been

• where you are today

• what you're hoping for

• and whether Viriditas Health is the right fit for your journey.

Every submission is personally reviewed by me.

If it seems we're a good fit, I'll personally invite you to schedule a complimentary Discovery Call.

Discovery Questionnaire

Wholistic Wellness & Integrative Health Consults

Every wellness journey begins with a story, and I'd love to hear yours...

Before we schedule a Discovery Call, I invite you to share more about you, where you're at now, and what you're hoping to achieve. Your responses help me prepare for a meaningful conversation and determine whether Viriditas Health is the right fit for your needs.

Please complete the following form and I will be in touch to schedule a call with you shortly.

Thank you for taking the time to start the conversation.

Full Name *

Date of birth *

Gender: *

Address

Street Address *

Country *

State *

City *

Postal Code *

Contact Information
Please provide your preferred email address and phone number so I can contact you regarding your Discovery Questionnaire and arrange a time for us to connect.

Phone *

Email *

What do you do for work? *

How did you hear about me?

If you could eliminate 3 symptoms, what would they be? *

Have you had any of the following exposures, currently or in the past? *Please select all that apply

Anything else I should know?

Please enter any applicable info

How much are these health concerns affecting your life? *

NOT AT ALLVERY MUCH

How committed are you to making changes to support your health? *

NOT VERYFULLY

Be honest!

Please note: Viriditas Health provides wholistic health education, wellness coaching, root-cause consulting, and related services. These services are educational in nature and are not a substitute for medical diagnosis, treatment, or care from a licensed medical provider.

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