Getting Started | Epoche Medical

Readiness Assessment

Take the next step in reclaiming your health.

Is this for me?

The first step to your health journey is taking our Readiness Assessment, which helps measure your current health state, where you want to be, and if we are an excellent fit to help you get there. We will then have a free 15-minute consultation to discuss the results of your readiness assessment.

Name *

Phone *

Email *

How important is it to you to make a change in order to reclaim your wellbeing? *

Very Important
Important
Neutral
Low Importance
Not Important

How important is it to you to take nutritional supplements as recommended? *

Very Important
Important
Neutral
Low Importance
Not Important

How important is it to you to keep a daily food diary? *

Very Important
Important
Neutral
Low Importance
Not Important

How important is it to you to make lifestyle changes? *

Very Important
Important
Neutral
Low Importance
Not Important

How important is it to you to rebalance your sleep habits? *

Very Important
Important
Neutral
Low Importance
Not Important

How important is it to you to practice relaxation or mindfulness techniques? *

Very Important
Important
Neutral
Low Importance
Not Important

How important is it to you to engage in movement or exercise regularly? *

Very Important
Important
Neutral
Low Importance
Not Important

Please rate your willingness to follow wellness related recommendations. *

Very Willing
Somewhat Willing
Neutral
Not Very Willing
Not Willing at All

Please rate the level of support you anticipate from significant people in your life. *

A Lot of Support
Medium Support
Some Support
Very Little Support
No Support at All

Please explain any circumstances that presents a barrier to your success. *

Please add any thoughts regarding how you may be best supported by the practice. *

By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging. *

I agree