By providing this information now, we'll be able to focus your visit on whatever matters most to you.
How would you rate your current state of health?
Stress is a big problem for me.
Use the <enter> key to make a new row after each entry.
I love to cook.
Units of Measurement for both Weight and Height
Do your responses reflect your situation and represent permission to use your de-identified data in aggregate scientific studies? Clients should be able to comfortably answer yes. If not, please call to discuss.
You will get a confirmation screen with results and an email summary if submission is successful.
On some devices, this form may fail to submit without an error message to help you fix the problem. If that happens, make sure you answered every item including those with radio buttons. This is the only problem you can encounter.
If the Security Phrase is rejected, check to make sure your auto-fill, auto-correct did not incorrectly capitalize the first letter or perpetuate an extra space before or after. On Apple devices you can hit the shift key to select lower case when starting the passphrase or toggle off Auto-capitalization under general settings for keyboard.