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Diverticulitis Rescue Yourself Membership Application

 

 
Hello and a warm welcome to you!

Thank you for your interest in joining the Diverticulitis Rescue Yourself Membership Community. Our program is carefully crafted to address the complexities of diverticulitis by integrating both mind and body in a holistic approach, aiming for a profound and lasting transformation in how you manage your health.

By completing this application, you are not just searching for solutions but also embracing the opportunity to deeply understand yourself and take control of your health challenges. This membership goes beyond a mere subscription; it is an invitation to join our inner circle that values mutual support, shared wisdom, and a collective journey towards overall health and wellness.

Your responses are incredibly valuable to us. They provide insight into your needs and goals, ensuring that we are aligned in managing diverticulitis holistically and supporting each other on this journey.

We are sincerely excited to learn more about you and explore how we can help in your diverticulitis recovery. Once you submit your application, please keep an eye on your email. We will be in touch to discuss the next steps and how you can join our supportive and empowering community.

Thank you once again for considering the Diverticulitis Rescue Membership. We look forward to welcoming you into our community.

Let’s begin. Click the button below to start.

Start

Question 1 of 13

Which age group do you fall into?

A

Under 20

B

21-30

C

31-40

D

41-50

E

51-60

F

61+

Question 2 of 13

How did you first learn about our Diverticulitis Rescue Membership Community?

A

Online search

B

Recommendation from a friend or family member

C

Free Facebook Group

D

Instagram

E

TikTok

F

YouTube

G

Reddit

H

Newsletter/Email

I

Other

Question 3 of 13

What are your main goals in joining this Diverticulitis Inner Circle Membership? 

(Select all that apply)
A

To learn more about managing diverticulitis naturally.

B

To find a supportive community that understands my condition.

C

To adopt a holistic lifestyle for long-term health benefits.

D

I'm not sure yet, I'm exploring my options.

Question 4 of 13

How long have you been experiencing symptoms or been diagnosed with diverticulitis?

A

Less than 6 months.

B

6 months to 1 year.

C

1-3 years.

D

3-5 years.

E

Over 5 years.

Question 5 of 13

Have you tried any treatments or lifestyle changes for your diverticulitis before?  If so, what kind and what was your experience?

Question 6 of 13

Are you familiar with the Diverticulitis Rescue 4 Stages? If so, which stage do you currently find yourself in?

A

Stage 1 - Liquids and Rest

B

Stage 2 - Soups and Smoothies

C

Stage 3 - Cooked veggies/no tough skins

D

Stage 4 - Salads, Nuts, Whole Grains

Question 7 of 13

How familiar are you with holistic wellness practices as compared to traditional Western medicine approaches for managing diverticulitis?

Our community is deeply rooted in holistic principles that prioritize the mind-body connection for healing and wellness.

A

Very familiar – I actively follow and incorporate holistic practices in my life.

B

Somewhat familiar – I have some understanding and have tried a few holistic practices.

C

A little familiar – I am aware of holistic practices but haven't actively incorporated them into my lifestyle.

D

Not familiar – I primarily follow traditional Western medicine approaches.

Question 8 of 13

On a scale of 1-10, how committed are you to making healthy lifestyle changes that could potentially improve your condition?

A

1-3 (Somewhat committed)

B

4-7 (Committed)

C

8-10 (Very committed)

Question 9 of 13

Our program emphasizes the importance of integrating mind-body practices for holistic healing. This includes a range of methods such as meditation, yoga, nutritional adjustments, and more, to support overall wellness.

 

What are your thoughts or experiences with such an approach?

A

Fully supportive – I believe in and have experienced the benefits of integrating mind-body practices.

B

Open to learning – I am new to this approach but eager to learn and experience its benefits.

C

Skeptical but willing to explore – I am more accustomed to traditional methods but open to exploring holistic practices.

D

Prefer traditional methods only – I am not interested in mind-body practices and prefer to stick with traditional approaches.

Question 10 of 13

To ensure you gain the most from our inner circle membership, attending live sessions and community support meetings is crucial. These events are scheduled according to the Eastern Time Zone (ET). Please select the options that best match your availability to participate in these events:

(Select all that apply)
A

Weekday mornings (9 AM - 12 PM ET)

B

Weekday afternoons (12 PM - 3 PM ET)

C

Weekday evenings (6 PM - 9 PM ET)

D

Saturday mornings (9 AM - 12 PM ET)

E

Sunday evenings (6 PM - 9 PM ET)

F

My availability varies, but I am willing to prioritize and attend these events as much as possible.

Question 11 of 13

Is there anything else you would like to share about yourself that you believe makes you a good fit for our membership community? 

Do you have any concerns or questions about our program that you would like to address before joining? 

Question 12 of 13

Please read the following Medical Disclaimer carefully: 

The Diverticulitis Rescue Membership and its content are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. The guidance and support provided in our program are meant to complement your health regimen and not replace professional medical care.

  

By selecting 'I Agree,' you acknowledge that you have read and understood this disclaimer. 

A

I Agree

B

I Disagree

Question 13 of 13

Please read the following Participation Disclaimer carefully:

By submitting this application, you understand that participation in the Diverticulitis Rescue Membership does not guarantee specific results. Health and wellness outcomes vary from person to person. You agree to participate fully and follow the program guidelines to the best of your ability. You also acknowledge that you are responsible for your own health and well-being throughout the program and in applying what you learn within the membership.

 

By selecting 'I Agree,' you acknowledge that you have read and understood this disclaimer and agree to its terms. 

A

I Agree

B

I Disagree

Confirm and Submit