Pathway Application

Steadfast accepts a limited number of new patients each month. This short application helps us determine fit, readiness, and which pathway may be most appropriate.

Please do not submit private medical information through this form. This application is for eligibility and scheduling purposes only.

Basic Info

Full Name

Email Address

Mobile Number

Date of Birth

Address

What Are You Looking to Improve?

What prompted you to reach out now? (Choose up to 3)

What would make the next 6-12 months a success for you?

Readiness + Fit

Which best describes you right now?

If accepted, how ready are you to follow a structured plan? (1-10)

Which statement fits best?

Pathway Direction

Which sounds closest to what you want?

Timing

If approved, when would you ideally start?

Preferred contact method

Final Step

Anything else we should know about your goals?(optional)

Please avoid private medical details.

I understand this is an eligibility application and not a medical intake form.

I understand that, if selected, the first step is an Initial Strategy Evaluation with an investment of $225, which is credited toward your pathway if choose to move forward.

All fields must be completed before submitting.