Vejon MED

ROOT Program Webinar Application Form and McMillan Monitor

Thank you for your interest in the ROOT Program. This exclusive webinar helps individuals overcome chronic health challenges by addressing root causes. Please complete this survey as your responses will help us assess your motivation, health needs, and readiness to invest in your wellness journey. Upon submission, you’ll also be added to our weekly VejonMed Newsletter list plus email with link for the McMillan Monitor. PLEASE CHECK SPAM/JUNK if not seen in your inbox!

Email*

1.What is your first name?*

2.What is your email address?*

3.What is your primary health concern or challenge? (Please provide a brief description of how this issue impacts your daily life. Do not share detailed medical history or anything you wouldn't feel comfortable sharing with a group.)*

4.How long have you been experiencing this issue?*

Less than 3 months

3-6 months

6-12 months

Over a year

5.How motivated are you to find a solution to your health challenge?*

Extremely motivated and ready to take action

Very motivated, actively seeking solutions

Somewhat motivated, but unsure of the next steps

Mildly motivated, exploring options but not urgent

Not motivated at this time

6.How willing are you to invest time and effort in a structured program to improve your health?*

I’m fully committed and ready to take action.

I’m interested but need more information.

I’m unsure if I have the time/energy right now.

7.Is there any other information you think is relevant (Do not share detailed medical history or anything you wouldn't feel comfortable sharing with a group.) ?

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Vejon MED

Your Health, Our Priority

ROOT Program Webinar Application Form and McMillan Monitor

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