Hello friends,
Please fill out the following survey. This will allow us to serve you better with your health needs and goals.
The Biamonte Center
In order for us to understand your needs and help you achieve your goal of good health, please complete this survey and email it back to us.
Name
Age
Address
Email address
Telephone
Primary Complaint
Occupation
1. What are the services that you are looking for in a clinical nutritionist?
2. What type of symptoms or health conditions are you trying to address?
3. How have you tried to correct these problems in the past?
4. Do you feel that sad, hopeless about trying to correct these problems?
5. How are your health problems affecting your life?
6. What are you unable to do because of your health problems?
7. Are your health problems ruining your life?
8. What service in addition to a nutritional program do you need? Examples would be; follow up testing, questions answered by email, blogs so as to communicate with others on the program, video’s that explain the program etc.
9. Is insurance coverage essential for you?
10. If not covered by insurance what would you be comfortable spending per month?
Thank you for your time. I hope we can work with you in acheiving your health goals.
Sincerely,
Michael Biamonte CCN