Health and Lifestyle Consultation Form

All fields are mandatory. The form below is secure and all of your information will remain confidential.

Name

First Name

Last Name

Date of Birth

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Age

Height

Current weight

Weight one year ago (estimate)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Skype

How did you hear about Global Health Renegade

Search engine

Media

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If you chose Social Media or Other above, please specify:

Consultation questions guidelines

Please be specific in relation to your question(s). If you ask a general question, you will get a general answer in return.

For example, if your question is: I’d like to know about the benefits of fasting, you are better off buying the Fasting book on our products page as this is more of a generic question. I want you to maximise your investment in this consultation so have a careful think about your question.

Example question:

I have rheumatoid arthritis. How could I help alleviate this condition?

What is your question?

Health Consultation Form

Health and Lifestyle Consultation Form