New Patient Booking Process
This form helps us get to know you and understand your health concerns before scheduling your initial visit. By learning more about your symptoms, goals, and health history, we can ensure you are scheduled with the right provider and that we are fully prepared to support you on your wellness journey. After completing this questionnaire our staff will reach out via your preferred method to schedule your initial visit. 
Email *
Have you previously been under care from a Functional Medicine Provider?  *
If Yes, who did you see?
How long were you at the practice?
Why are you wanting to switch providers/offices? 
Are you currently in an active treatment plan or when were you last in a treatment plan?
How long have you been dealing with your symptoms? *
What medical diagnoses have you been given? *
What symptoms are the most severe currently? *
Have many doctors (functional or traditional medicine) have you seen for your symptoms/conditions? *
What treatments have you already tried? *
Are you looking for symptom relief or root-cause healing? *
Are you willing to follow a structured treatment plan over several months or Interested in a Wellness Membership where you can pick your wellness services? *
Are you open to dietary and lifestyle modifications and/or supplement changes and recommendations?
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How motivated are you to get better? *
Low
High
What is your expected timeframe that it will take to feel better? *
Are you open to advanced functional testing that isn't covered by insurance, if needed? *
Are you open to supplements or therapies if recommended *
Have you invested in your health before? Tell us more. *
How would you like us to reach out for scheduling?
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