First Name *

Last Name *

Email *

Phone *

Where do you live? (Currently Dr. Huntington is licensed in Idaho, Utah, and Texas.) *

Idaho
Texas
Utah
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What are your primary concerns or symptoms? *

Weight Gain and/or Metabolic Issues

Digestive Issues

Low Mood/ Depressive Symptoms

Fatigue/Sleep Issues/Brain Fog

Hormone Imbalances

Chronic Stress/Anxious Symptoms

Other

How often do these symptoms impact your life? *

How often do these symptoms impact your life?

Everyday
Most Days
Some Days
Infrequently or never
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How long have you experienced symptoms? *

Less than 6 months

6 months to 1 year

1 to 3 years

Over 3 years

What steps have you taken to address these symptoms? *

Lifestyle changes: Nutrition, exercise, mindset work, stress reduction

Functional medicine testing, supplements, IV or other treatments

Conventional medicine (medications, mental health therapy, procedures)

None of the above or other

Are you interested in PERSONALIZED root cause care of your symptoms, where appropriate, that may include functional medicine labs, high-quality supplements, significant lifestyle changes, and/or prescriptions for weight loss or hormone replacement? *

Yes

Are you willing to set goals and challenge previous habits or barriers to achieve better health? *

Yes

Are you willing to meet monthly/work with the doctor for the next 3-6 months? *

Yes

What are your top two health goals for the next 6-12 months? *

What has been the most challenging barrier to improving your health in the past? *

Please indicate if you meet any of the following *

End-stage disease of the liver, kidneys, lungs, heart, active seizure disorder requiring medications, or an uncontrolled/unstable medical condition

Pregnant, breast feeding, or plan to become pregnant in the next 6 months

Active Cancer (including on treatment with chemotherapy or other modality)

None of the above

PLEASE NOTE : We serve patients ages 18-64. We DO NOT bill insurance (we do accept HSA, FSA), and we CANNOT accept patients that have Medicaid or Medicare. *

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