STEP 1: What Are You Currently Struggling With? (Select all that apply) *

Fatigue or low energy

Brain fog or memory issues

Numbness or tingling in feet/hands (neuropathy)

Weight gain or difficulty losing weigh

Poor blood sugar control despite medication

I'm on meds, but not improving

I feel okay but want to prevent disease

Other: ________

STEP 2: What’s Your Current Diagnosis? *

Type 2 Diabetes

Pre-Diabetic

Metabolic Syndrome

Insulin Resistant (diagnosed or suspected)

Not formally diagnosed, but experiencing symptoms

Other / Not Sure

STEP 3: How Long Have You Been Dealing With This? *

Less than 1 year

1–3 years

3–5 years

Over 5 years

I’m not sure

STEP 4: What Treatments Are You Currently Using? (Select all that apply) *

Prescription meds (Metformin, Insulin, etc.)

Diet and exercise

Supplements

Nothing yet – looking for a solution

Other: ________

STEP 5: What Are You Hoping to Achieve with Treatment? (Select up to 3) *

Get off medication or reduce dependency

Improve energy and clarity

Reverse neuropathy or other symptoms

Lose weight

Prevent future complications

I’m not sure yet — just exploring options

STEP 6: Do You Have Any of the Following Conditions? (Select all that apply *

High blood pressure

Cardiovascular disease

Chronic Kidney Disease

Chronic inflammation

Hormonal imbalance

Autoimmune conditions

None of these / Not sure

STEP 7: Are You Ready to Take Action on a New Treatment Approach? *

Yes — I’m ready to make a change now

Possibly — I’d like to learn more

Not sure yet — just exploring

STEP 8: What Is Your Zip Code? *

STEP 9: How Would You Prefer to Be Contacted? *

Phone Call

Text Message

Email

First Name *

Last Name *

Phone *

Email *

NEXT