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Apex Life and Longevity
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Weight loss/body optimization
Energy maximization
Male and female hormone correction
Allergy cessation
Cognitive and neurological enhancement
Longevity enhancement
Apex life and health coaching
Dr. George
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Dr. George Gauthier
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Apex
Life and Longevity
Application form
How important is it for you to unlock your apex performance, both mentally and physically?
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1
2
3
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5
How did you find out about us?
Internet / Google
Social media
Through a friend
Other
What is the main reason you want to join our program?
How long have you been suffering from this problem?
Do you have any of the following problems?
Digestion, Reflux, Gas, Constipation
Sleep: Falling asleep or staying asleep
Brain Fog
Fatigue
Low Energy
Allergic Reactions
I have less muscle mass and more body fat than I would like
My libido is not what it once was
Low Motivation Levels
What have you tried in the past to resolve these problems?
What results did you get from previous methods to resolve your problem?
What are your top three concerns when it comes to your health?
What past investments have you made in yourself?
Personal trainer/Health Coach/Business Coach
Lab Testing
Diet and Nutritional Changes
Hormones/cosmetic surgical procedures/full-body scan
I never invested in any program or service in those categories
Other
What is your full name?
What is your occupation?
What is the best email to reach you?
What do you believe is holding you back right now?
If you are accepted, when are you ready to start the program?
Today
Within the Next Week
Within the Next Month
Undecided/Not Ready Yet
Which of our services would you be interested in?
Weight Loss/Body Optimization
Energy Maximization
Male and Female Hormone Correction
Allergy Cessation
Cognitive and Neurological Enhancement
Longevity Enhancement
Apex Life and Health Coaching
Submit
