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Consultation Inquiry

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Name *

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How do you prefer to be contacted?

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Why are you interested in Being. ? *

What areas to you want to improve upon?

Energy

Sleep

weight loss/weight gain

pain/discomfort

mobility

strength

posture

sense of community

consistency

mindfulness

Where are you on your Wellness Journey?

Where are you right now?

I am WILLING to begin enhancing me life

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Agree

Strongly Agree

I am ABLE to begin enhancing my life

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am READY to begin enhancing my life

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Disagree

Neutral

Agree

Strongly Agree

What is your Being? *

If other, describe your Being: *

Thank you!

Looking Forward to connecting with you.

1192 Bedford Ave, Brooklyn 11216 | 646.770.2431 | info@beingtherapeutics.com