First Name *

Last Name *

Date of birth *

Email *

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

How did you hear about Wandering Bear Wellness? *

What are you goals for receiving work from Wandering Bear Wellness? *

How long do you think it will take to achieve this goal?

What have you tried in the past to alleviate your concerns? *

Why is working with Wandering Bear Wellness the right approach for you at this time? *

What's your biggest obstacle or frustration you're encountering? *

If needed what is your willingness to change your diet? *

I understand that renewed health and vitality comes with time and may push me out of my comfort zone. *

• YES
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Does anyone else need to be on the call to help with the decision? *

• yes
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What questions/reservations do you still have? *

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