YAY! We'd love for you to attend!

Fill out the form below so we can get an idea of where you're at in your health journey. After you fill out this form, you'll be able to schedule a call with a member of my team to get your questions answered and any other information you need.

Tell Us About Your Needs

First name

Last name

Email*

Phone

What is the #1 goal for your health right now?

What do you feel is your greatest challenge in reaching this goal?

The Retreat Team will stay connected with Dr. Erin and eachother for an entire year. How would it make you feel to have that much support for your goals?

On a scale of 1-5, how supportive is your significant other when it comes to your health goals?

1- zero support

2- Almost no support

3- indifferent

4- pretty supportive

5- extremely supportive

N/A

How much have you invested over your lifetime in your personal health and wellness? (i.e. books, courses, diet plans, gym memberships,coaches, doctors appointments, specialists, weight loss sugery, medications, etc.)

$1--$100

$101-$500

$501-$2,000

$2,001- $10,000

$10,000+

Do you have the financial resources available to invest in yourself and your health goals?

Yes - Totally ready to invest in my health

Maybe - I may need to look into financing opportunities

I have very limited financial resources and do not want to finance

Questions?
Email us:
support@emergencyhealthfix.com

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