I look forward to helping you achieve your highest level of wellbeing.
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Before we begin our journey together, I would like to discuss something very important that will have a major impact on your ability to live with high performance and obtain your highest level of wellbeing. 

Having more than two decades in professional medical practice, I have had the opportunity to work with several thousands of patients and have seen the vast majority of them achieve significant improvement while other have become frustrated and failed in their attempt to get well. 

After careful review, I have discovered the reasons why some people succeed and why others fail. The following questions are about much more than eliminating your symptoms -- it's about living a life of vibrant wellbeing.

I've discovered that any discussion of the correct way to achieve health and stay healthy is, in actuality, a discussion of how you have lived your life up to this point and how you will live in the the future.

Therefore, to help you make significant changes in your present health, I want to ask you a few very important questions, I want you to be honest with yourself and really dig deep inside yourself for the answers.

 
What do you hope to achieve in your visit with me? *

 
If you had a magic wand and could erase 3 problems related to your health, what would they be? *

 
Have you made the decision to change? To do what it takes to reach your highest level of wellbeing? *

     
 
Most people realize that it is the definition of insanity to keep doing the same thing and expect different results. In order to shed those things that hold you back from living with high performance you must come to admit that all that you have done and are currently doing are not getting you that desired result. 

Most people I ask tell me they've  made the decision to change. However, how many have truly decided to change? Very few! Why?

Because there is a big difference between deciding something and having "reasons" to actually do it. 

When you have made a decision to make a change and you know your reasons, you create an internal power that can propel you to achieving health and wellbeing. So now I ask:

 
List up to 5 things that you have been unable to do as a result of your present level of health and/or symptoms. Please be very specific. *

 
List up to 5 things that you plan to do once you are feeling better. Please be very specific.

 
Are there any other health goals you want to achieve? Please be very specific.

 
In order to get the result you desire, how willing are you to do the following: (5 stars being highest)

 
Significantly modify what and how you eat? *






 
Perform laboratory assessments that include collection of blood, urine, stool, and/or saliva? *






 
Take several nutritional supplements each day? *






 
Keep a detailed record of everything you eat each day? *






 
Modify your lifestyle (e.g. work demands, sleep habits, environment)? *






 
Practice relaxation techniques daily? *






 
Engage in exercise 2 days a week ? *






 
Have periodic lab tests to assess your progress? *






 
How confident are you of your ability to organize and follow through on the above health related activities? *






 
If you are not confident of your ability, what aspects of yourself or your life lead you to question your capacity to fully engage in the above activities?

 
At the present time, how supportive do you think the people in your household will be to your implementing the above changes? *






 
How much ongoing support and contact (e.g. telephone, email correspondence) from your professional staff would be helpful to you as you implement your personal health program? (5 being the need for more frequent contact) *






Thank you for taking a few moments to complete these questions and I look forward to speaking with you at your upcoming appointment.
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