Assessment
Thank you for your interest in getting the best healthcare with Upper - wellness and all natural!  We are glad you found us and truly look forward to bringing you great joy, health, and total relief as your newly preferred health system.

This intake will help us understand how to help you.
Sign in to Google to save your progress. Learn more
Email *
Your Name (First & Last) *
Phone Number *
City, State, Zip Code (where you live / where you prefer your care professionals to operate). *
Tell us about your general health and wellness status, experiences, and what brought you to this Help Assessment.  Share whatever you'd like regarding who you are and what situations you may be facing. *
Do you know which type of care you're looking for?  Check all that apply. *
Required
If you chose "Other" above or would like us to know exactly what type of care you need, please let us know in detail here.
Your Maximum Monthly Budget for Health & Wellness *
Do you have health insurance? If yes, what provider and plan? Please feel free to email a copy of your insurance card to get@ontheupper.com.  Sometimes, going through insurance is a cost-savings, but not always.  We will provide you with best savings options regardless.
Do you have a Health Savings Account (HSA) or Flexible Spending Account (FSA)?  So far, Upper is qualified to accept HSA's.  Yes, you can use them on our site! *
Male/Female Provider Preferences *
Communication & Care Delivery Preferences (check all that apply).  How would you like to attend care? *
Required
Please feel free to share any other comments or questions you'd like us to know here.
Now it's time to speak with our Concierge, who can ensure that your wellness investments are as efficient and effective as possible.
Learn more and book a Concierge Visit with us here.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of ontheupper.com. Report Abuse