This is an invitation to you to connect with me regarding your Wellness.

Your Name:                                  Email:                                         Cell:

Delivery Address:

This will questionnaire will help me to understand your Stamina and Vitality requirements.

With health, anything is possible.  Without health, you  would need to settle for limited options.

Please outline your current health status:

What are your most pressing health concerns?

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What are you currently doing about these concerns?

          1        a)

                    b)

                    c)

          2        a)

                    b)

                    c)

          3        a)

b)

                    c)

What is your blood group?

Are you ill, weak, irritated?

Rate out of 10 your stamina and vitality?

Are you in recovery, wanting to lose weight, training?

What are your health goals?

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I look forward to us traveling a healthier journey together.  All the best, Barbara

Dr Barbara Johnson  http://wellnessdimensions.blogspot.com   082 784 7656 

YOU MAY PRINT THIS OUT, fill it out and then send it to my email address:

DrBJ@WellnessDimensions.co.za