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: https://www.celestialholisticarts.com/_files/ugd/133a34_f1d2f0fd10f044abafe83b31aa9d5908.pdf

Type NA if no insurance or not using insurance 
*
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