Please fill out this questionnaire for us to understand how we can best help you

First Name *

Last Name *

Phone *

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Describe how you feel on a day-today basis currently? *

If you could work with Ben Greenfield and his team, what area would interest you the most? *

What has been your biggest roadblock to sustained health and wellness success? *

If you were able to work with Ben and his top experts over the next 90-180 days, what would be your biggest goal? Please be detailed... *

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