Tell Me About Your Health Goals and Challenges!

I'd like to hear from YOU! What do you think about your health challenges? What type of support would you like to see from me?

1What's your name? 

2What's your email? 

3What's your greatest health challenge?* 

4Comments 

5What's your greatest challenge when it comes to finding the support you need?* 

6Comments 

7Regarding your health challenges, what specific areas of support are you looking for? 

8Comments 

9Are you looking to purchase programs, services, or products to support your health challenges?* 

10What type of programs, services, or products are you thinking of purchasing? 

11Other comments. 

12What are you willing to pay for the type of help you're looking for? 

13Comments 

14What topics do you want me to write about on Rebuilding Wellness? 

15What topics and articles do you like me to share on my business Facebook page (FibroWHYalgia)? 

16Is there anything else? 

* This field is required.

 

Optional.

 

This is optional and may only be used if I'd like clarification on your response(s).

 

Even if more than one response applies, please choose one main answer.

 

Please share any comments you may have about this question.

 

Please choose the main problem even if more than one applies.

 

Please share any comments you may have about this question.

 

Please choose as many as you like.

 

Please share any comments you may have about this question.

 

Please select one.

 

Please choose all that apply.

 

Please share any comments or list other products or services you may be looking for.

 

Please mark one answer.

 

Please share any comments you may have about the above question.

 

Share topics of interest for my blog, RebuildingWellness.com.

 

Share topics, tips, news,etc. that interests you most.

 

Please share any comments or feedback you may have about your needs, frustrations, and desires.