How Has Your Condition(s) Affected Your Relationships, Family, Finances, Or Other Activities?
What Has It Cost You In Time, Money, Sleep.....Happiness?
Where Do You See Yourself In The Next Year, Three Years, Ten Years If These Issues Are Not Addressed?
What Is Your Health And Wellness Worth To You?
Are You Willing And Able To Invest In Yourself, Both In Time and Money?
What Is Your Main Health Goal?
Why Is This Goal Important To You And What Do You Think Is Stopping You From Reaching It?
Are You Coachable Or Open To New Ideas?
Are You Willing To Commit To Long Term Lifestyle Change?
Do You Have A Support System/ Is Your Spouse Or Significant Other Supportive?
Intake Form Link
When you complete and submit our New Patient Intake form, one of our experienced team members will call you to confirm your information and schedule a 45-minute, one-on-one phone consultation with a Practitioner. During this consultation, we will determine if you are a good candidate for our functional medicine and preventative health program and then, together, we will decide if our practice is a good fit for you. When you make the decision to move forward with care, we will go over the program, registration process, and payment options.
To get started, click on the Intake Form Link Below.
Be sure to have enough time, about 30 minutes, to fill out the entire intake form in one sitting.
If you cannot complete the form in one session, each time you access it, the site will ask for a one-time passcode that you will receive in a separate email message at that time.
Feel Free to contact us with any questions or technical issues.
Intake Form Link
