* Please enter your name
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* Please enter little bit about yourself.
How committed to resolving your health conditions are you on a scale of 1-10? 1 2 3 4 5 6 7 8 9 10
* Is it more important to see fast results, or sustainable health for the rest of your life?
* Do you have a support system at home?
* Why do you feel Empowered University is a program that can help you?
* Have you had success getting healthier in the past?
* Are you diagnosed with any medical conditions?
* What are your top three goals you want to achieve from this program?
* How many years have you been trying to improve your health?
* Do you believe your health is in your control? If not, why?
* Do you believe that you can achieve better health?
* What motivates you to improve and maintain your health?
* Do you believe the human body can heal from disease?