More About You * Required for consultation *Full Name *City *State *Time Zone *Email Address *Best phone number? *Age *Date of Birth *Relationship Status *Children *Occupation *Main reason for contacting Lyfe Nutrition *Any serious illnesses, conditions? How is/was the health of your mother? How is/was the health of your father? *Any pain, stiffness or swelling? *Constipation/Diarrhea/Gas? *Allergies or sensitivities? Please Explain: *Do you take any supplements or medications? Please list: *Healers, helpers or therapies with which you are involved? *Example of your daily food intake: *Percentage of food is home-cooked? *Do you have cravings or other major addictions? *How would you describe your relationship with food? *What in my life needs to improve in order to live my best lyfe? 1 + 13 = Send Terms of Use Privacy Policy
