Congratulations! You’re Taking Back Control of Your Health
A Few Quick Questions Will Help You Get Real Answers

For educational purposes only. Dr. J. Von Hill, D.O. (Ret.), is not a practicing physician and does not provide medical diagnosis or treatment.

Full Name

Your Email *

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When Were You Born?

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Your Primary Health Goal...

What do you most want help with in the next 30–60 days?

If we made one meaningful improvement this month for you, what would it be?

Let's Talk About Sleep...

Do you struggle with sleep?

Yes - trouble falling/staying asleep, waking unrested.
No
Sometimes
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What You're Trying

How are you treating this now?

A. Prescription Medication

B. Supplements/Wellness Products

C. Not treating it

D. Other

(Optional) If you answered A or B what products are you using?

How About Pain?

Do You Struggle With Pain?

Yes - joint pain / headaches / muscle tension
No
Sometimes
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What You're Trying

How are you treating your pain?

Physical Therapy

Prescription Medication

Supplements/Wellness Products

Not treating it

Other

(Optional) Tell me more about your pain.

Are You Anxious, Stressed, or Depressed?

Symptoms could include low mood, anxiety, brain fog, focus.

Yes, one or more of these things bother me
No
Sometimes
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How Are You Dealing With Any of These?

How are you treating yourself for: (PTSD / Stress / Anxiety, etc.)

Prescription Medication

Ketamine Treatments

Therapy / Counseling

Natural Supplements/Wellness Products

Not Treating It

(Optional) Tell me more about your mental health.

How's Your Weight & Metabolism?

Is weight or cravings (sugar/salt) a challenge?

Yes
No
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Weight & Metabolism

Which best describes your current challenge(s)?

Slow metabolism

Food cravings/appetite

Energy crashes/fatigue

Hormonal changes

Want to reduce weight

Belly fat or other problem areas

Unsure

How are you currently treating these concerns

Medication

Natural Supplements

Exercise

Not treating it

Other

(Optional) Tell me more about your concerns.

How's You Immune System?

Are you concerned about your ability to stay well?

Yes
No
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Tell Us More...

Which best describes your concerns?

Seasonal colds/flus

Autoimmune issues

Frequently sick

Slow recovery from illness

General preventative wellness

Unsure

(Optional) Anything else we should know?

How's Your Digestion?

Are you concerned about your gut health?

Yes - Digestive system / Microbiome health
No
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Digestive wellness

Which best describes your symptoms?

Bloating or gas

Constipation or diarrhea

Food intolerances

Acid reflux/heartburn

(Optional) Tell us more about your gut health.

Let's Talk Skeletal

Are you concerned about your bones & joints?

Yes
No
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Bone & Joint Health

Which best describes your concern?

Bone strength/density

Joint stiffness/arthritis

Injury recovery

Other

(Optional) Tell us more about your bones & joints.

Let's Talk Energy

Are you concerned about your energy levels? (copy)

Yes
No
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Low Energy or Fatigue

Which best describes your condition?

Overwhelming tiredness

Muscle weakness

Need naps, frequently

Cognitive issues / Poor concentration

Memory and mood changes, such as irritability

(Optional) Have you ever been diagnosed with something that may explain this?

Thank You for Taking Control of Your Health!

Dr. Hill will review your submission and send a reply to you by email. Your next step is to book your FREE consultation with him after submitting this form.

Please Note: The wealth of information and personal service provided by Dr. Hill is for general educational and wellness purposes only. Dr. Hill holds a Doctor of Osteopathic Medicine (D.O.) degree. He has chosen not to currently hold a license to practice medicine, as he does not want to be told by medical boards and Big Pharma how to help people. He does not act as your physician. No diagnosis, treatment, prescription, or "medical care" is offered. Using this site or participating in a session does not establish a physician–patient relationship. Always consult your licensed healthcare provider for any questions about a medical condition, medications, or starting/stopping supplements. Call 911 for emergencies.

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