The Revitalize Program Application
Please Answer Each Question Thoroughly.
We need to make sure you're a good fit for our program.
Is this your first time applying for our help?
This is My First Time Applying
I've Applied Before
Which areas do you need the most help with?
Health & Vitality
Mental Health
Disease Management
Getting Clear on Goals
Boundaries and Habits
Better Sleep and Recovery
How certain are you about your present strategy?
Confident- I just need some specialized help
Not so much...it's confusing or not working as well as I'd like
It's not working and I need a new path
How much would you be willing to invest in a solution that works for you? Please be as accurate as possible.
Don't have the finances now, but maybe in the future.
$200 to $1k - As much as a nice TV or furniture.
$1k to $3k - As much as a nice vacation.
$3k to $5k - As much as a bathroom upgrade.
I'll invest what I need to as long as it works for me.
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