Custom Checklist For Practitioners

The Practitioner Challenge

“I have not failed. I've just found 10,000 ways that won't work.” - Thomas A. Edison
Health Practitioners and therapists understand reversing Chronic Disorders, such as Lyme Disease, can be complex and difficult. Millions, struggling to restore their health, are unaware a myriad of 'ways' exist which guarantee they fail... practical, physical, psychological, emotional, energetic and more.
Practitioners may review Health Questionnaires and Client Intake Forms, for clues. However, these are usually limited to brief history and a few lifestyle questions. ​Too many 'ways' or 'healing blocks', are missed. A more comprehensive Form is needed.

"Exciting" New Tool.

The new Healing Blocks Checklist is certainly comprehensive, identifying 150 healing blocks in 15 categories. Available for Chronic Disease and Lyme Disease, the forms are online, interactive, modern and client-friendly. "Old-fashioned", fillable PDF versions are available, for those who require them.
I hesitate to call any Form "exciting". Yet, once seen, Practitioners quickly recognize the Checklist to be one of the most important new tools in the Healing Toolbox. Filling crucial gaps in our knowledge, raising client awareness and engaging them, more, in their own recovery.

FREE Version

A FREE version of the Online Checklist is currently 'live' and accessible to all. Send clients a link to the Chronic Disease or Lyme Disease edition. Ensure they enter your email address, when SUBMITTING the form. Review their responses. Then work with them, to clear their personal blocks. You can view them, here.

Custom Version

It's a terrific Checklist but it's not YOUR Checklist. Understandably, You want YOUR items, YOUR branding, YOUR products and YOUR services. That's fine. You can order a Custom version right now and have the form deployed, in just a few days. Read on for details...

The Problem With PDFs

  • Time consuming to manually enter data.
  • Inconvenient to complete, print and return.
  • Prone to errors when completing.
  • Not mobile-friendly.
  • ​Cannot edit.
  • Data is locked. 
  • Unable to do further data analysis.
  • Difficult to ensure data security and privacy.​

Features

  • Modern, beautiful design.
  • Collects client details.
  • Over 150 Healing Blocks.
  • Organized into logical groups.
  • Client-friendly check-boxes.
  • Completed Online.
  • Responses can be automatically saved and emailed to the client.
  • Your own dedicated Web Page.
  • ​Showcase your Brand, Business Details, Products, Services, Special Offers.
  • ​Customizable.
  • Multimedia.
  • QR Codes and embedded, clickable links.
  • Mobile-friendly (landscape view).
  • Fillable PDF version available.

Benefits

  • Done-for-you.
  • Gathers crucial health information.
  • Real-Time Data.
  • Easy to access, edit and update.
  • Efficient. Complete in 10 minutes.
  • Work more easily, with clients, to identify & resolve issues.
  • Opportunity to provide additional services.
  • Increases profitability.
  • Saves time on investigation.
  • ​Builds your Client List.
  • ​Increases client awareness and engagement.​​
  • Reduces Practitioner workload.
  • Eliminates paper management.
  • Data securely saved and backed-up.
  • Allows Data Integration via Zapier or similar.​

Practitioner Showcase

Online Forms do far more than collect data. They are important Marketing tools. A ​Health Form not being leveraged is a lost opportunity.​

Your Business Card

Your Multimedia

Your Products

Your Call-To-Action

ROI

Return on Investment (ROI) is fast. As few as 1 customer or as quick as 1 day. Add its lifetime value (LTV) and the business case is compelling.

Demand

Emailing your client list, announcing the new form, is a reminder of your existence. Shining new light on their health challenges, stimulates demand for your services.

Dorothy

Dorothy is battling chronic disease. Completing the checklist made her realize she can't do it, alone.
Dorothy books a 1hr Consult with you.

Linda

Linda thinks 'Unresolved emotional trauma' could be blocking her from healing.​
She books an 'Emotional Release' session.

Helen

Helen has Chronic Lyme Disease and realizes she needs an individualized program.
She buys your Lyme Disease Protocol

John

John wants Ozone but it's too expensive. He sees your Special Offer on the Checklist
He purchases a 10-Pass Ozone Package

Customer Testimonial

"Really good tick list survey that makes you question, honestly, where you might be going wrong in treating Lyme disease. Very quick and simple to complete even with a Lyme brain."
​- Amy Higgs

Who Can Benefit From A Custom Checklist?

Natural, Alternative or Integrative Health Practitioners, working with Chronic or Lyme Disease, at practices, clinics and healing Retreats.

Options & Prices

Choose the Online version, PDF, or both.

Option 1

ONLINE FORM
  • Your Logo.
  • Your Business Card.
  • Your Products & Services.
  • Your Special Offers.​
  • Your Multimedia.
  • Your QR Codes.
  • Your Embedded links.
  • Add/Remove Items
  • Call To Action.
  • ​Dedicated Web Page.

$425

Option 2

PDF FORM
  • Your Logo.
  • Your Business Card.
  • Your Products & Services.
  • Your Special Offers.​
  • Your Images.
  • ​Your QR Codes.
  • Your Embedded links.
  • Add/Remove Items
  • ​Call To Action.​​
​

$425

Option 3

REMOVE COPYRIGHT NOTICE*

$299

*Does not negate Intellectual Property Rights.

Value Packages

V1

Custom Online Form + PDF

$625

V2

Custom Online Form + Remove Copyright

$625

V3

Custom PDF + Remove Copyright

$625

V4

Custom Online Form + PDF + Remove Copyright​

$825

V5

Edit Form (Online or PDF)*

$60

*Fee is per edit. For major changes, please ask.

Cross-Promote

Another way to leverage Custom Forms is through Cross-Promotion. Practitioners add each other's Products and Services to their Checklists.

Practitioner A

Works with Lyme Disease. Would love to refer a Lyme Disease Retreat

Practitioner B

Runs Lyme Disease Retreats. Would be happy to refer Medical Ozone.

Cross-Promote

A lists B's Lyme Disease Retreat.
B lists A's Ozone.

Benefits

  • Increased visibility.
  • Increased customer base.
  • Increased sales.
  • Improved customer experience.
  • Increased referrals.
  • Improved reputation.

Interested in a Partnership?

What You Receive

  • Custom Online Checklist and/or Fillable PDF Form.
  • Your own dedicated Web Page.
  • Hosting and Backups of Form and Client Data.

Your Data is Secure

Your Web page and Custom Form is hosted on secure Square servers. 

Methods of Payment

Payment is via Stripe Payment Portal

Here's What I Need From You

  • Header Image for your Checklist Web Page - 1920 x 1080 pixels or 1500 x 900 (width x height).
  • Digital Business Card with your Company name, Logo, contact details, etc.. - 1625 x 473
  • Images of Products, Services and Special Offers.
  • Any Multimedia, audio or video.
  • Links and QR Codes.
  • Texts or Quotes.
  • Your Calls-To-Action e.g. 'Buy Now', 'View Details', 'Book A Consult'

Tips For Using The Form

- Overloading the form with too many offers and distractions may be seen negatively, by clients.
- Provide an incentive to complete the form.
- Provide an incentive to provide a Testimonial for your form.

Copyright or Copyrite

Copyright Law protects text, images, layout and design of Forms. Any unauthorized use or reproduction of the form or its elements may be a violation. Advances in tracking technology and greater enforcement mean the risk is neither worth it, nor necessary. The Form is already FREE to all. Fees, for custom versions, are modest.