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P: 908-520-2234

F: 908-867-0059

E: inquiry@ethosprimarycare.com

A: 177 West Mill Road, Long Valley, NJ 07853

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It is not intended to be a substitute for informed medical advice or care.
You should not use this information to diagnose or treat any health issue without consulting your doctor.
Always seek medical advice before making any lifestyle changes

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1. What MOTIVATES you to be healthier?(Required)

a) On a scale of 1(Not At All Important) - 10(Very Important), how MOTIVATED are you to make changes to improve your health?(Required)

b) On a scale of 1-10, how CONFIDENT are you that you can make changes to improve your health?(Required)