“Best Next Move” Health Strategy Session

Free Life-Changing Consultation with Pam Bartha

($500 value)

Thank you for reaching out. Your health is very important to us.

We are happy to offer you this FREE life-changing consultation with Pam but before we do, we would like to know a little bit about you so we can make sure that we are a good fit for you – that we can help you. 🙂

This free life-changing consultation with Pam will give you clarity on the most important steps you should take now so you can get back to doing all the things you love to do.

Because there are a limited number of spots available, it is important that you fill out this form with as much detail as possible so that we can serve you in the best possible way.

We want you to know that there is hope for recovery and we are excited to support you!

** PLEASE NOTE- All questions with an asterisk (*) must be answered, or the form cannot be submitted.

** We will need your permission to communicate with you and give you health updates through emails so make sure to click on the box in the form so we can support you.

IMPORTANT – Because the Live Disease Free approach involves eating a moderate amount of animal protein, you will not find a consultation helpful if you avoid animal products in your diet.

Live Disease Free Consultation Survey

Yes - I want to receive emails and health information updates from Pam Bartha *

How young are you? *

Do you have support at home (spouse, partner, family member, etc)? *

Are you still able to work?

Yes

Part-time

Full-time

If you answered "Yes," what type of work do you do?

If you get well, would you like to go back to work? If so, what type of work would you do?

What disease condition(s) do you suffer with? *

When were you diagnosed with your condition? *

What are your health concerns?

Poor digestion - gas, constipation

Cravings for breads, sugar, alcohol and / or chocolate

Fatigue

Foggy head

Poor memory

Pain

Depression

Anxiety

Poor Balance

Spasticity

Numbness

Weakness in legs

Bladder issues

Vision affected

Mobility affected

I can walk without a walking aid

I use a cane

I use a walker or rollator

I use a wheelchair

What are your health concerns?

Cholesterol

Blood pressure

Bladder problems

Anti-depressant

Anxiety issues

Pain medication

Prescription sleep aids

Anti-inflammatory

Medications specific for my condition

Please list below:

If you are not taking medication for your condition, is this by choice or because there are no effective medications for your condition (ie. progressive MS)?

Where would you like to be with your health? What are your health goals? *

What things have you done to try to reach your health goals? For example - solely medical standard of care (maintenance medication), physiotherapy, acupuncture, chiropractor, Chinese medicine, functional medicine, naturopathy, homeopathy, stem cell therapy diet, supplements, exercise, CCSVI ... other? *

Have you had long lasting benefits from any of the treatments and supplements that you have tried? *

Do you eat a strictly plant-based diet (no animal products)? *

How is your disease impacting your life? For example – loss of work, financial hardship, loss of independence, loss of friends, isolating yourself, not able to do the things you loved to do, heartache, fear… *

What are your long term concerns about living with your disease condition(s)? If you don’t figure this out and stop the disease, where do you think it could go? *

Does your poor health impact your life in any other ways or in other areas of your life? In what specific ways is this holding you back? *

Precisely what else is getting in the way of you achieving your goals? *

Why is it so important for you to beat this and get your health back? What is your WHY?! *

On a scale from 1 - 10 (where 10 reflects that you are 100% ready and committed to doing whatever it takes to get well) how prepared are you to invest both your time and finances into getting your health back? *

Contact Information

Date

First Name *

Last Name *

Phone *

Skype contact for those living outside of North America or have area codes 218 (Northern Minnesota) or 712 (Western Iowa) - This is Required

Email *

Street Address *

City *

State *

Zip *

Country *

Signature

Please enter your full name: *

Were you referred by someone? I’d love to know (and appreciate) those spreading the word!

Referred by

Thank you for sharing from your heart. This helps us figure out where you are and how to best support and serve you. Each question in this interview must be answered honestly and thoroughly for us to know if we can help you.

This free life-changing consultation with Pam will help you figure out the most important next steps you must take to get your health and life back.

You will receive an email from us within 24 – 48 hours. Please watch your inbox but also your spam, junk and promotional folders for the information you will need to begin to move towards reaching your health goals.

We are excited and honored to support you!

** Click the button below if you have filled out the form and you're ready to discover a new and effective way to live your best life!

“Best Next Move” Health Strategy Session

Free Life-Changing Consultation with Pam Bartha

Live Disease Free Consultation Survey

Contact Information

Signature

Were you referred by someone? I’d love to know (and appreciate) those spreading the word!

Contact Information

Signature

Were you referred by someone? I’d love to know (and appreciate) those spreading the word!

I will teach you how to take back your health so you can live your best life.

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