SPA 05 – Wellness Collective

3 minutes to your personalized wellness plan, let’s go!

LET’S CREATE YOUR PLAN

Whose plan are we creating? *

LONGEVITY + WELLNESS

What are you looking to do? *

[check all that apply]

Stay Active
Stay Fit
Stay Relaxed
Stay Young
Stay Well

LONGEVITY + WELLNESS

On a scale of 1 - 10, how would you rate your overall Health + Wellness?

Slide the scale from left to right to choose the desired number.

Selected Value: 1

LONGEVITY + WELLNESS

Regarding your Health and Wellness, what are you most interested in: *

Appearance
Anti-Aging
Physical Performance / Sports Recovery
Pain Relief
Weight Loss/Gain
Muscle Tone
Energy + Focus
Relaxation
Immune Boost
Sexual Performance
Incontinence
Overall Wellness

Appearance

Which area of the body they are most concerned about? *

Face
Lips
Neck
Arms
Stomach
Thighs
Buttocks
Hair Growth

Focus on:

Appearance

Regarding your face, lips or neck, what are you hoping to correct? *

Acne
Fine Lines / Wrinkles
Thinning/Sagging/Crepey Skin
Scaring
Skin Tightening
Skin Smoothing
Volume Loss/Facial
Saggy Neck

Focus On:

Anti-Aging

To reach your Anti-Aging goals, what areas are you most wanting help with? *

Appearance of Face, Lips or Neck
Hair Loss
Sexual Function
Incontinence
Mental Clarity/Focus
Energy
Muscle Tone
Arthritis

Focus On:

Anti-Aging

What are you looking to improve with Sexual Function: *

Orgasms
Duration
Erectile Dysfunction

Focus On:

Anti-Aging

When are you experiencing Incontinence? *

Occasional spotting/dripping during social funtions
While laughing/coughing/sneezing
During activities and/or lifting
Complete Bladder Loss

Focus On:

Physical Performance/ Sports Recovery

Regarding your Physical Performance/ Sports Recovery what would you most like to improve? *

Neck/Back Pain
Joint Pain/Arthritis
Inflammation
Range of Motion/Flexibility
Muscle Tension
Muscle Soreness
Sport Injury
Muscle Building
Energy + Focus

Focus On:

Focus on:

Physical Performance/ Sports Recovery

Any known disc related problems? *

Focus on:

Pain Relief

Regarding your Pain Relief what are you looking to improve? *

Neck/Back Pain
Joint Pain
Inflammation
Range of Moton

Focus on:

Pain Relief

Any known disc related problems? *

Focus on:

Weight Loss/Gain

Regarding your Weight, are you most interested in? *

Weight Loss
Weight Gain

Focus on:

Weight Loss/Gain

Which areas of the body are you looking to lose weight? *

Stomach
Thighs
Arms
Buttocks
Overall Body

Focus on:

Muscle Tone

Regarding your Muscle Tone, what body part(s) are you most interested in: *

Abdomen
Inner Thighs
Outer Thighs
Buttocks
Biceps
Triceps
Calves

Focus on:

Energy + Focus

Are you currently experiencing: *

Tired/Fatigue
Loss of Focus
Stress/Anxiety
Depression
Irritability

Focus on:

Relaxation

How would you rate your overall stress? *

Not stressed
Mildly stressed
Moderately stressed
Over the Top Stressed!

Focus on:

Relaxation

Where do you hold tension? *

Neck
Back
Shoulders
Everywhere

Focus on:

Immune Boost

What are you hoping to accomplish by boosting your Immune System? *

Help with Allergies
Fight Chronic Fatigue
Decrease Headaches
Improve Optimal Health and Wellness

Focus on:

Overall Wellness

How many hours per week do you spend recharging your body and mind? *

Zero, I’m always on the go!
1-3 hours per week
4+ hours per week
I focus on doing something daily

Focus on:

How old are you? *

18-25
26-30
31-35
36-40
41-50
50+

What is your gender? *

Male
Female

In the past what services have you experienced and found most helpful for your overall wellness? *

Massage
Chiropractic
Decompression
IV Therapy
NAD+ Therapy
Regenerative Medicine Stem Cell/PRP
Cold Water Plunge
Stretch
Other

Other Service

YOUR CUSTOM PLAN IS READY.

WHERE SHOULD WE SEND YOUR RESULTS
+
COMPLIMENTARY VIP DAY PASS?

Enter Your Email Address *

Also, please provide the best phone number for one of our concierge consultants to use in scheduling you for your free day pass.

Phone Number *

Checkboxes *

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