Complete our 1-Minute Survey to Claim Your Consultation Today!
Do you struggle with any of these symptoms?
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Fatigue
Maintaining Desired Weight
Constipation/Diarrhea
Brain Fog
Trouble Falling Asleep
Hair Loss
Other
Have you struggled with unusual constipation or loose stools?
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Yes
No
Have you been diagnosed with an Autoimmune Disease or Thyroid Disorder?
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Yes
No
How many doctors have you seen for this problem?
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How many doctors have you seen for this problem?
1
2
3
None
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What have you tried in the past that has not corrected your problem?
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What is your Pain/Discomfort Level on a scale of 0-10?
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Do you understand that this is for a 100% Virtual Consultation?
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Do you understand that this is for a 100% Virtual Consultation? This question is required.
Yes
No, I would like to go into the office for treatment
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We currently do not work with any insurance providers, in doing so we are not limited by insurance's standard care and can find the root cause of your problems to help you truly heal. Do you wish to continue?
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Yes
No
Possibly, if I had more information.
First Name
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Last Name
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Email
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Phone
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