Request Your Complementary Discovery Call?
At The Functional MDs, we deliver one of the highest standards in functional medicine — blending advanced diagnostics, precision protocols, and physician expertise to achieve meaningful, lasting change.

Because our care is deeply individualized and time-intensive, we accept only a limited number of new patients who are ready to take an active role in their health journey.

Completing this brief form helps us ensure that our program is the right fit — so we can dedicate our full attention to every patient we serve.

First Name

Last Name

Phone *

Email *

On a scale of 1-10 (1 being "not at all", 5 being "somewhat" and 10 being "I'm 100% ready!"), how ready are you to commit and make the necessary changes to achieve your goals?

How did you hear about us?

What are the specific health challenges you are seeking treatment & wellness care for? *

What are your BIGGEST obstacles to achieving your health goals?

What are you looking for most in a health care provider? (choose all that apply)

Listens to me

Looks at the big picture (holistic approach)

Collaborates with me to help me make the best health decisions for my circumstances

Looks for the root cause of my medical problems, instead of just addressing my symptoms

I understand The Functional MDs is not contracted with any health insurance company. *

Yes, I understand that The Functional MDs is not contracted with any health insurance companies.

To ensure we spend time and attention with all of our patients, we are only able to accept new patients who are ready to transform their health. Are you ready? *

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