Consultation Prep - The 7 Systems Plan

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Congratulations!

We’ve received your payment.

In order to make our time together as valuable as possible, please answer the following questions pertaining to your health.

This will help me better understand which of your system(s) are having issues and make our time together as valuable as possible.

Once you complete the questionnaire, you will be taken to the booking page to schedule your appointment.

7 Systems Plan Consultation Questionnaire

First Name(Required)

Last Name(Required)

Email(Required)

Phone Number(Required)

1. What are your main health concerns?(Required)

2. Have your been diagnosed with any disease (please list)?(Required)

3. How much weight do you want to lose (if any)?(Required)

4. What medications are you on?(Required)

5. What supplements are you taking?(Required)

6. List the significant lab tests you have had done that are out of normal range (if any).(Required)

7. Are you willing to make some changes?(Required)

9. Do you struggle to lose weight?(Required)

Sometimes

Frequently

9. Do you have digestive problems, constipation, or acid reflux?(Required)

Sometimes

Frequently

10. Do you have cravings for or eat food that is not good for you?(Required)

Sometimes

Frequently

11. Do you have high blood pressure or high cholesterol or take medications for them?(Required)

Sometimes

Frequently

12. Do you struggle with low energy?(Required)

Sometimes

Frequently

13. Do you have hormone problems, low sex drive or sleep problems?(Required)

Sometimes

Frequently

14. Do you have inflammation, joint pain, or auto immune disease?(Required)

Sometimes

Frequently

15. Do you have brain fog, unexplained muscle pain or ringing in the ears?(Required)

Sometimes

Frequently

MEDICAL DISCLAIMER

The content included in this program is for informational and educational purposes only. It is not intended to provide medical advice or replace the advice or treatment of a personal physician. All readers/viewers of this content are advised to consult their physicians or qualified healthcare professionals regarding any specific health concerns. The information contained herein is provided without any representation or warranty, either express or implied. The mention of specific companies, organizations, or authorities does not imply endorsement by the author, nor does the mention of specific companies, organizations, or authorities imply their endorsement of this book or its author. Dr. Luse is not responsible for any potential health consequences for anyone who reads or follows the information contained in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their doctors before starting any nutrition, supplement, or lifestyle program.

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