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Do you see patients that you know you can help, but you don't yet have the knowledge yet?
Do you still have gaps in your understanding and integration of functional medicine? We can help with a practice analysis phone call. . This form is a guide for us to help us learn where there may be GAPS in your functional medicine education. It will help us prepare for your practice analysis phone call. Thank you for your interest in improving patient outcome by getting more education in functional medicine


Practice Analysis Questionnaire

Email address *
Name: [First & Last] *
Your answer
Address:
Your answer
City:
Your answer
State:
Your answer
Zip Code:
Your answer
Phone: *
Your answer
How did you hear about us? *
Your answer
Are you presently a practitioner who is actively working with patients / clients on their health? If so, briefly describe your style of work (if not, skip down to section II):
Your answer
On average, how many patients / clients do you see per week?
Describe your fee structure for sessions:
Your answer
Do you work?
Do you sell herbs / supplements / health products? If so, do you stock them in-office?
Your answer
Do you offer packages, group sessions, educational programs, movement classes, or other offerings? If so, please describe:
Your answer
What are your license(s) / certification(s)?
Your answer
Are you currently ordering functional medicine labs? *
Please check what functional labs you currently order: *
Required
Are you looking to add additional labs to your practice?
Your answer
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