Holistic Pediatrician Dr. Lisa DeFusco Ancira

First Name

Last Name

Email Address*

Cell Phone

Question 1

What information do you want from your pediatrician that you feel you are not receiving?

Question 2

Question 3

What concerns do you have regarding your child's nutritional needs?

Nutrient Requirements

Organic vs Non-organic

Avoiding processed foods

Picky eater

All above

Question 4

Do you have concerns about the home environment such as

Air Quality

Cleaning supplies

Electronics

All above

Question 5

What is your source for knowledge in solving your questions and concerns?

Pediatrician

Internet

Friend and Family

Books

Question 6

Question 7

What type of community resources would be most valuable to you?

Online discussion forum or message boards

Live chat or Q&A with holistic pediatrician or experts

Webinar or online workshops on holistic body care topics, nutrition, ect..

Access to other parents going through the same phase of life

Access to downloadable resources and guides

Local meetups or events for parents in the same area

Question 8

Would you be willing to contribute your own experiences, insights, or resources to the holistic community?

Yes, definitely

Yes, occasionally

Maybe, depending on the topic

No, prefer to be a passive member

Question 9

Are you willing to pay a membership fee or subscription to access premium features and content within the holistic community?

Yes, I see value in premium content of a holistic community.

Maybe, depending on the cost and features

No, I prefer free access

Question 10

Would it be helpful to have support from a holistic pediatrician and community to answer your questions?

Yes

No

Question 11

Are you questioning the traditional medical model, such as vaccines?

Yes

No

Question 12

Do you believe vaccines are necessary?

Yes

No

Question 13

Do you want alternatives to traditional treatments for common ailments?

Yes

No

Question 14

Do you believe pharmaceuticals are a long term solution?

Yes

No

Question 15

Question 16

Feel free to leave any information/comments/feedback that will help us provide the highest possible value to parents.

Question 17

In order to better serve your family leave the box below checked. If you are happy to provide information to serve others and do not want to be contacted uncheck the box below.

I agree to recieve marketing emails to the email address provided

Parents First Family Membership

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