Dr. Nancy Crowell - Reclaim Your Energy Session

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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Area Code
Phone Number
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What is the health condition or symptom that most affects the quality of your life?* This field is required.
5
Have you ever worked with an alternative or holistic health practitioner on this imbalance?* This field is required.
YESNO
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If so, what was the result?* This field is required.
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What kind of lifestyle do you have? What do you eat? How often do you exercise? What do you do for a living? How much time do you spend outdoors on a daily basis? * This field is required.
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Large
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Small
Ok
Ok
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Why do you want to get to the root of this health condition? What impact is it having on your life?* This field is required.
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What do you feel is the biggest challenge that is stopping you from reaching your health goals? * This field is required.
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Large
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Small
Ok
Ok
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Knowing that working with Dr. Nancy and her team is very limited, why do you feel YOU are one of the women she works with this year?* This field is required.
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Small
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Ok
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Right now I....* This field is required.
Have the financial resources to invest in my health
Have access to the financial resources to invest in my health.
Am willing to source financial resources for my health
Don't have any financial resources at all and I am going to keep my health exactly where it is at.
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When do you want to get to the root of your health condition?* This field is required.
Now
within 6 months
within a year
no timeline
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How did you hear about Dr. Nancy?* This field is required.
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If I found a program that would radically change my health for the better, was a perfect fit and the investment was 5 figures I would....* This field is required.
know that my health is my greatest asset and be fully committed.
would be a little intimidated, yet with a proven system I would do it because I'm serious about my health
Avoid it at all costs because I want to do things as cheaply as possible.
15
Are you interested in applying for funding for this program that would allow you to divide payments over 3 to 5 years?
YESNO
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If you answered yes above, do you make $40k or more and have a credit score above 620?
YESNO
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