Honest Family Medicine Contact/Waitlist Form
Honest Family Medicine is a Direct Primary Care Clinic in St Peters, MO. Dr. Mitchell and her staff are working hard to provide the most comprehensive, affordable and personalized care possible for their patients. In order to ensure appointment availability and to provide the time and attention that each patient deserves, sometimes this means that we close enrollment to new members for a while. The purpose of this form is to notify us of your interest in joining Honest Family Medicine so that we can contact you when enrollment opens.

If you have questions about the clinic before joining the waitlist, please complete the contact form on our website first so that we may answer them. 
Thanks so much for your interest!

Please note that when we accept new patients, we will send you an email from inquiry@honestfamilymed.com. We typically will follow this email up with a phone call/ voice mail whenever possible. If we don't get a response after 2 attempts to contact you, we will move on to the next person on the list. PLEASE BE SURE TO CHECK YOUR EMAIL SPAM FOLDER AND YOUR VOICEMAIL. 

Email *
First Name *
Last Name *
Phone Number *
How did you hear about Honest Family Medicine? *
Required
Please share the name of your friend, family member or acquintance that told you about us! (optional)
Are you familiar with the Direct Primary Care concept? *
How many members of your family (including yourself) are you hoping to enroll with Honest Family Medicine? (It is completely fine if you are not sure.)  *
Do you currently have a primary care physician?
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Is there anything in particular you are hoping to get help with upon enrollment? *
Are you interested in finding a fully-trained family medicine doctor or help with a functional medicine concern? *
Please note that functional medicine consultations, testing and treatment will incur extra costs on top of the monthly clinic fee.  *
Required
Do you have Medicare Insurance benefits? *
Please be aware that we do not bill insurance at our clinic for your care. Rather, you pay a monthly fee for better access to your doctor and cash prices for blood work and medications. You can use your insurance for routine bloodwork, medications, radiology studies, referrals, etc. 

Check the boxes below if you understand these statements:
 *
Required
Please be aware that Honest Family Medicine requires at least one adult to enroll with a child under 18 years old.  This is because we value the family unit as a whole and understand that the genetics, illnesses, goals, home environment and relationships within a family are very important for comprehensive healthcare. *
Direct primary care clinics like Honest Family Medicine are an affordable and convenient way for business owners to provide health benefits to their employees.  
Are you a business owner that is interested in learning about healthcare options that are much more affordable than traditional insurance plans?
 *
Required
If you answered "Yes! Please tell me about other options!" regarding employee insurance and health plans, would you like for us to pass your information along to a trusted insurance broker that can create an affordable plan for you/ your employees? (This is NOT spam and we would NEVER sell your information to anyone. We simply want to connect two fantastic groups of people.)  *
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