Discovery Call Application 
Welcome!

I’m thrilled to help explore what’s possible with your health. This application is for a 20 minute phone Discovery Call with me, Dr. Angela Carlson. It’s the first step in determining if my holistic functional medicine approach is the right fit for your needs and goals. 

This call is designed to give me a clearer understanding of your current health concerns, past experiences, and the outcomes you’re hoping to achieve.

Please answer the questions as thoroughly and thoughtfully as possible. Your responses help me evaluate whether my services align with your expectations and allow us to make the most of our time during your Discovery Call.

Once I review your answers, I’ll reach out via email with the next steps. I typically respond within 3-5 business days.

Thanks again.
I look forward to connecting with you soon!

Warmly, 
Dr. Angela
Sign in to Google to save your progress. Learn more
Email *
First and Last Name *
Date of Birth : MM-DD-YYYY *
MM
/
DD
/
YYYY
Phone number ###-###-#### *
What is your zip code?  *
How did you find my website? Please check all that apply. *
Required
If you marked other - please explain. If not, write N/A. *
Regarding pregnancy and fertility, please pick the statement that applies to you:  *

Please briefly list your top 3 health concerns. List in order of importance to you.

 *

What made you decide to explore a holistic, functional approach at this time?

 *

What are your goals for working with a holistic doctor?

 *

What have you tried in the past to address these concerns? (e.g., medications, other providers, diet changes)

 *
What are your BIGGEST OBSTACLES to achieving these goals? Please check all that apply. *
Required
If you marked other - please explain. If not, write N/A. *

Are you currently taking any prescription medications? If yes, please list. If not, type "no."

 *

Do you have any diagnosed conditions or chronic illnesses? If yes, please list. If not, type "no."

 *
Individualized holistic health care takes commitment and consistency. For example, creating new habits around nutrition, sleep, movement, mindset, and supplements. How ready are you to make necessary diet & lifestyle changes so that you can feel better? 
 *
My approach helps identify and address root causes of your symptoms with a personalized, holistic plan, which requires a significant investment. Are you willing and able to invest $2500-$3000 to finally get more clarity and start feeling better?  *
Due to current licensing laws, we are currently unable to accept insurance, including Medicare and Medicaid within the state of Nevada. You understand we do not bill any insurance plans, and that payment is required to begin care? *
Required
Have you taken the time to review the Foundations of Healing New Client Package, including the investment and are ready to book a Discovery Call? 
 *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms