New patient and client waiting list
Submit the following information to apply for Celestial Holistic Arts' waiting list for appointments with Lara Thompson, ND. 
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Do you believe that BIPOC (black, indigenous, people of color), LGBTQIA* (lesbian, gay, bisexual, transgender, queer, androgynous, intersex, asexual, ++), and disabled lives matter? *
First Name *
Last Name *
Email address *
Phone number  *
How did you find us? *
What about working with this provider resonates with you?  *
What issues are you needing support with?

What prompted you to reach out?
What have you done or are you currently trying to address these issues? 

How do you think working with this provider will help?
What medications and supplements are you currently taken or have you tried to address your concerns? *
Are you hoping to use health insurance for services?

If so, what insurance plan do you have?

To confirm coverage, complete the insurance verification form here:

Type NA if no insurance or not using insurance 
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