Name* First Last Phone*Email* Date* MM slash DD slash YYYY Gender*MaleFemalePrefer not to discloseOccupation* Health HistoryWhat are your top 3 health goals for the next 6 months?*If you could eliminate 3 concerns related to your health, what would they be?*Within the past year what has been your biggest health struggle?*Have you invested in your health in the past?*YesNoWhat needs to happen in your life for you to change your health patterns?*If you overcame your top 3 struggles how do you think that would affect you financially and with your personal relationships?*Health GoalsDo you have any fitness goals for the next six months?*YesNoWhat are those fitness goals?*Are you in the mindset to commit to your health optimization?*YesNoAre you willing to get lab testing to analyze and quantify what is happening in the body?*YesNoAre you willing to wear a self quantification device to track your activity, sleep, and recovery?*YesNoAre you ready to make a five figure investment in your health?*YesNoHow did you learn about Dr. Cordial and his Elite program?*CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
