check

Clarity Call Application

Interested in working with Dr. Sara? Please fill out this application to get started.

Click the button below to start.

Start

Question 1 of 15

What the primary reason for seeking consultation with Dr.Sara?

Question 2 of 15

How long has this topic of concern been on your mind?

A

Less than a month

B

Less than 6 months

C

6 mos- 1 yr

D

More than 1 yr

Question 3 of 15

Please describe you current level of physical activity

Question 4 of 15

How you would describe your current nutrition & dietary habits?

Question 5 of 15

Please indicate your level of commitment to self-care and previous treatment plans you may have engaged in with other clinicians

A

None

B

Some, when I had time

C

Lots, I always make time

Question 6 of 15

Do You Smoke?

A

Yes

B

No

Question 7 of 15

Do You Drink Alcohol?

A

Yes

B

No

Question 8 of 15

How motivated are you to get better?

A

Not motivated at this time

B

Somewhat motivated

C

Moderately motivated, I'm ready to step it up

D

Highly motivated, I'll do whatever it takes

Question 9 of 15

Please indicate behaviors you are UNWILLING to change 

(Select all that apply)
A

Intensity of physical activity &/or style of exercise

B

Nutrition & dietary habits

C

Alcohol intake

D

Smoking

E

Lifestyle & behaviors like sleep hygiene, morning routine, water intake etc.

F

other

Question 10 of 15

How much time do you have to commit to your health and wellness?

A

I don't have time

B

I'm really busy, but I can make time

C

I'm busy, but I will make time

D

I have plenty of time

Question 11 of 15

Please indicate your ability to financially invest in your health and wellness. *This helps Dr. Sara guide you towards solutions that align your needs.

A

I don't have the budget

B

Resources are limited, but I am willing to make a budget

C

I have the budget

Question 12 of 15

How did you hear about Dr. Sara & Advantage Body Solutions?

Question 13 of 15

Please indicate below that you are aware that Dr. Sara and Advantage Body Solutions are cash-based fee-for service practices and do not accept insurance.  

A

I am aware.

Question 14 of 15

Which option best describes the role you see Dr. Sara playing in your care?

A

I'm not sure yet

B

I want to work directly with Dr. Sara in-person in Arizona

C

I want to work with Dr. Sara in a Virtual format

Question 15 of 15

Your Contact Information:
 Please provide your Name, phone number, and e-mail address so someone from the office can contact you once your application has been reviewed.

(Please keep an eye out for communications from Dr. Sara in your SPAM folder)

Confirm and Submit