Please provide your details below so we can contact you regarding your patient onboarding.

What are your top 4 reasons/complaints for seeking care at 417 Integrative Medicine?

What providers have you seen for your current symptoms/concerns?

Have you seen a functional medicine provider in the past (or current)?

How long have these concerns been going on?

List treatments/medications you have tried.

Are you currently taking any prescription medications or supplements? If so, please list (briefly)

How willing are you to implement supplements/vitamins into your daily routine? (scale of 1-5)

How willing are you to make dietary and lifestyle changes? (scale of 1-5)

How willing are you to take prescription medications? (scale 1-5)

Are there specific types of treatments or therapies you are interested in?

Is there anything else you would like us to know to help match you with the best provider?

Do you have a preference on which provider you see?

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