Please Complete This Form To Schedule Your Consultation

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.

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

Please enter your full name *

Your phone number *

We will call you directly at the time of your appointment

Your email *

By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. Message frequency may vary. [Privacy Policy Link]. Reply Help for more information. You can reply STOP to opt-out of further messaging.

Please share a few words about the health challenges or concerns you are hoping to get support for *

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?

What matters most to you in a healthcare experience? (choose all that apply)

How did you hear about us?

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

Yes, I understand

To ensure we give every patient the time and attention they deserve, we accept a limited number of new patients who are ready to invest in transforming their health. Are you ready to take this step?

Yes, I am committed to transforming my health

Our practice is currently able to provide care to patients located in the following states: Indiana, Ohio, Michigan, Kentucky, Illinois, Pennsylvania, Washington, and Texas. Please check the box below to confirm you currently reside in one of the states listed above. *

I confirm that I currently reside in, or am willing to travel, to one of the states listed above