START YOUR FUNCTIONAL WELLNESS PROGRAM TODAY

Step 1:  Complete the form below.
Step 2:  Pick a time on Dr. Jones calendar for your initial Discovery Call (phone or webcam).
Step 3:  During the Discovery Call, you'll find out if you're a good candidate. If you are, he'll let you know the next steps.


Part I


Part II

Your first step towards better health begins with this simple questionnaire. Please pick the most appropriate number for the next 10 questions. 0 as the least/never, and 3 as the most/always. 


Part III

Rate on a scale of 1-10 (10 being most important):