Complete Our Short Health Questionnaire

Please take a moment to answer this quick health form before proceeding with your booking.

Tell Me About Your Health Goals

1. What are your primary health concerns? (Check all that apply) *

Weight loss

Gut health (bloating, IBS, constipation)

Hormonal issues (fatigue, menopause, libido)

Men’s health (low testosterone, ED)

Chronic symptoms or inflammation

General wellness or prevention

I’m not sure—I just need support

2. What are your top 1–3 health goals right now? *

3. Have you worked with a functional or holistic provider before? *

Yes

No

4. Are you currently taking any medications or supplements? *

Yes

No

If yes, please list them:

Other (Please specify):

I understand that if I do not attend my scheduled Root Reset Starter Session call with Essence Integrative Care, and fail to provide at least 24 hours’ notice of cancellation or rescheduling, I will no longer be eligible for another no-charge session.

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DISCLAIMER: This training is in no way associated with or sponsored by Instagram® or Facebook. We make no promises or guarantees that you will get these same or similar results or any result at all. This free training does not constitute a practitioner/patient relationship and is strictly educational. If you choose to join the free program provided and purchase any supplements offered, we will receive a commission on the sale as an ecommerce transaction.

Complete Our Short Health Questionnaire

Please take a moment to answer this quick health form before proceeding with your booking.

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Terms & Conditions | Privacy Policy