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PEAK Client Application Form

Helpful information to help guide us on we can best help you!
It only takes 5-10 minutes of your time and all answers are confidential. 

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Question 1 of 14

Name

Question 2 of 14

Your Best Email

Question 3 of 14

Age

Question 4 of 14

Occupation

Question 5 of 14

How did you hear of PEAK Integrative Wellness? If a person directly referred you, what is their first and last name?

 

Question 6 of 14

Program I am most interested in:

A

PEAK+ Method

B

PEAK+ Total Body Blueprint

Question 7 of 14

PEAK Integrative Wellness is a high-level concierge service, for high-level results. We want you to know you'll be FULLY supported and truly cared for when choosing PEAK. We go above and beyond, always catering to what we know would leave you feeling amazing, inside and out. We also value FUN, and focus on health in a way that elevates your entire life - even your social life! We are on a mission to help you live in this modern world and optimize certain key things that will help you truly thrive, feel more energetic, get a better handle on your stress and routines, and resolve any nagging symptoms you may have.

A

Yes! I want this!

B

No, I'm not interested in changing my health and upleveling my life

Question 8 of 14

What are your top health goals in the next 3 months? Be specific:

Question 9 of 14

What are your top health goals in the next 3 - 6 months? Be specific:

Question 10 of 14

If you could erase 3 problems related to your health, what would they be?

Question 11 of 14

What has been your biggest struggle to reaching those goals?

Question 12 of 14

What (or who) in your life has been negatively impacted as a result of your present level of health?

Question 13 of 14

What are you most excited about happening if in a few months from now you are feeling, looking, and performing better than you ever have?

Question 14 of 14

The investment for one individual to work with PEAK Integrative Wellness 1:1 for 3-6 months access is a 4-5 figure investment. PEAK accepts a very exclusive number of clients every 6 months to work with privately. Are you mentally and financially ready to commit to your health in this way?

A

Yes! Absolutely! Let's do this!

B

No, not ready to take charge of my health.

C

Maybe, but I need more info

Confirm and Submit