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What to Expect
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Home
About Us
Medical Team
What to Expect
Client Portal
Contact
Please complete this brief questionnaire.
Open Questionnaire
Prospective Client Questionnaire
Name
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First Name
Last Name
Email
*
Phone
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How did you hear about our practice?
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Please list your top three complaints or concerns.
*
Please list your current medications.
*
How many providers have you seen for these issues?
*
What would you define as a successful outcome for your care?
*
Thank you!
