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New Patient Waiting List - Dr. James Huang (
www.drjameshuang.com
)
Thanks for your request to schedule. We will contact you as soon as there is availability.
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First and Last Name
*
Your answer
Phone Number
Your answer
Age
Your answer
Email Address
Your answer
What are your favorite sources for health news?
Your answer
What other clinics have you been to for your health?
Your answer
What is the best way to reach you?
*
Email
Phone
Instagram
Other:
Which would you prefer? Text message or Phone call?
*
Text message
Phone Call
Other:
When is the best time to contact you?
*
Morning (8-12)
Afternoon (12-6)
Anytime
What is your availability for an appointment? (Day and Time)
*
Your answer
Which location would you like to visit?
*
Walnut Creek, CA
Oakland, CA
Truckee, CA
Orange County/ Los Angeles, CA
Why do you want to see Dr. Huang?
*
Your answer
On a scale of 1 to 10 how much pain are you experiencing?
*
1
2
3
4
5
6
7
8
9
10
How did you hear about Dr. Huang?
*
Your answer
Where do you live? (City, State, Country)
*
Your answer
How effective is wearing a mask to stop the spread of COVID-19?
*
Not effective
1
2
3
4
5
6
7
8
9
10
Very effective
Do you have any chronic health issues that you are dealing with currently?
*
Your answer
Dr. Huang does not work with insurance.
Are you still interested in scheduling an appointment?
*
Yes
No
Do you use social media? (Instagram)
*
Yes
No
If answered yes to the question above. What is your instagram?
*
Your answer
Do you have an iPhone (this is mainly for remote sessions)?
*
Yes
No
Thanks for your request! Looking forward to connecting soon!
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