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Dr. Cheryl Kam: 12 Month Integration Program

Welcome!

Do fill out this application to help me understand you a little better.

I very much look forward to meeting you!

Click the button below to get started. 

Start

Question 1 of 15

1. Name

Question 2 of 15

2. Email

 

Question 3 of 15

3. Contact Number

(Please include the country code, as needed. E.g. +65)

Question 4 of 15

4. Are you a...

A

Business Owner / Side Hustle Owner

B

Employed Full Time

C

Employed Part Time

D

Caretaker/Stay-at-home Parent

E

Side Hustle Owner

F

Not Employed

Question 5 of 15

5. I am applying as a

A

Patient

B

Practitioner

C

Possibly Both

Question 6 of 15

6. What would you consider your current health and wellbeing to be?

A

Poor. I don't take care of my health.

B

Okay, but not great. Sometimes I do healthy things.

C

Decent. I do my best to keep to a routine.

D

Great. I have an optimal routine that works for me.

Question 7 of 15

7. What are your 3 biggest struggles/obstacles with your health and wellbeing? 

Question 8 of 15

8. What is the biggest change that you want to see / feel in the next 3 months?

Question 9 of 15

9. How many hours a week do you spend on your personal development?

(Books, podcasts, audibles, courses, etc.)

A

None

B

1-2 hours / week

C

3-5 hours / week

D

Daily

Question 10 of 15

10. What best describes your clarity in direction?

A

No clue what I'm doing and why.

B

I have an idea on what I want to do, but don't know where to start.

C

I don't want much, I just want to be okay.

D

I know exactly where I want to go and how I'm going to get there.

Question 11 of 15

11. On a scale of 1-10, what is your level of commitment to achieving that change (10 being SUPER committed)

A

1

B

2

C

3

D

4

E

5

F

6

G

7

H

8

I

9

J

10

Question 12 of 15

12. What would be one thing you'd like to gain from this call with me?

Question 13 of 15

13. If you are a good fit to work with me...

A

I have the financial resources to invest in improving my health, biz, energy and confidence. I'm ready to stop delaying and change my life!

B

I will find the resources to invest in my health as I know this will also improve other areas of my life.

C

I am not looking for any coaching, just applying for a one-off consult.

Question 14 of 15

14. If the need arises, do reschedule using your calendly confirmation email in good time.

Last minute reschedules, cancellations or no-shows will incur the full fee of the consult 

A

I agree

Question 15 of 15

15. Last question: Tell me one thing that's awesome or super unique about you!

Confirm and Submit