Schedule a Meet & Greet

Name*
First Name Last Name
Email*
Phone*
Preferred method of contact
- Email
- Phone
Location*
What day and time of day are best for you?
What programs are of interest to you?
What motivated you to seek out Essential Health? Select all that apply.*
- I am looking for a new primary care physician.
- I have a specific health problem I would like to speak to someone about.
- I am interested in a functional medicine approach to my care.
- I was referred to by a healthcare provider, family member or friend.
Do you have previous experience with functional and/or integrative medicine?*
- Yes
- No
Do you currently have a primary care provider?*
- Yes
- No
What is most important to you in your search for a healthcare team? Select all that apply.*
- Patient/provider relationship
- Availability of appointments
- Specialized programs
- Location of office
How willing are you to invest in taking steps to improve your health? (5 Being the most willing to invest)*
- 1
- 2
- 3
- 4
- 5
I understand that Essential Health services are out-of-pocket - we do not accept insurance and we are not in network with any insurance companies. We are also unable to provide codes or diagnoses for reimbursement.*
- Yes
- No
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