Hi ,

Thank you for joining us!

To make sure the evening is tailored to your health goals, please take our quick 2-minute pre-event survey here →

Your answers help us show you exactly how light-activated regenerative technology can support your energy, recovery, and longevity.

Thank you!

Full Name *

Phone *

Email *

1. Which of these are you currently dealing with? (Select all that apply) *

Back pain or stiffness that interferes with daily activities

Neck pain, tightness, or limited range of motion

Chronic inflammation or joint discomfort

Slow recovery after exercise or activity

Low energy / afternoon crashes

Poor sleep quality

Reduced mental clarity or focus

Desire to improve skin appearance or overall vitality

None of the above – I’m mainly curious

2. How much is this affecting your daily life or performance? *

Mild – noticeable but manageable

Moderate – impacts work, workouts, or sleep

Significant – limits what I can do

Severe – I’m actively looking for solutions

3. How long have you been dealing with these issues? *

Less than 3 months

3–12 months

1–3 years

More than 3 years

4. What is your #1 goal right now? *

5. Have you tried other approaches for these issues? (Select all that apply) *

6. Would you be open to a non-invasive solution that works with your body’s natural healing ability? *

Yes

No

"Thank you, ! We’re excited to see you at our program.

You’ll receive a personalized wellness plan based on your answers.

See you soon! Patricia