Consultation Questionnaire - Genie Nutrition

Full Name

Email Address

Phone Number

What is your main health complaint?

How often does it bother you?

How long has it been going on?

What have you tried so far (that hasn't worked)?

What does this prevent you from doing/enjoying?

What (or who) would prevent you from completing a health-rebuilding program?

What Country/Time Zone are you in?

Do you have any additional comments you would like to share with me?

How did you find out about Genie Nutrition?:

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