New Patient Inquiry

New Patient Inquiry
Hello and thank you so much for considering the NATURAL HEALING CENTER for optimizing your health. Please know that we are experiencing a tremendous demand at this time and ask that you please FIRST fill out this form. You'll then receive a call from our New Patient Manager, Laura. Together you can decide if our practice is a good fit. Your submission will be placed in que and you will be called in the order received. Sometimes it may take a couple business days to get back with you due to the number of inquiries we get.

Thank you so much in advance for your patience. Of course we cannot make promises, but we feel pretty certain it will be worth the wait.

To your health,

Dr. Rodney Russell & Team
If you've not watched the video on our website, we recommend you do so to get a better idea of our founder Dr. Rodney Russell's, and the team and NHC's, overall approach to health and wellness.
Full Name*

First NameLast Name
City, State*
Date of Birth*

MonthDayYear
Date
Phone Number*
E-mail*
example@example.com
What is your top challenge that you would like us to help you overcome?*
What are your secondary concerns, if any?
Are you willing to do what's necessary to reclaim your health? (This may include, dietary modifications, functional lab testing, lifestyle adjustments, emotional healing and environmental modifications)*

YesNo
Do you consider yourself coachable?*

YesNo
FINANCIALS

Fees

Dr. Rodney Russell

Func Med New Patient (1.5 Hours + 1 Hr New Patient Advocate Success Coach) - $589

Func Med Follow Up (:30 Min)* - $125

Chiropractic / Emotional Release* - $125

*Must be an established Dr. Russell patient to do follow-ups

Dr. Julia Augustyniak

Func Med Follow Up (:30 Min) - $94

Chiropractic (:15 Min) - $55 or (:30 Min) - $94 (Packages available on :15 min. visits)

Holistic Nutition & Lifestyle I (:60 Min) - $189

Holistic Nutrition II (:30) - $94

Dry Needling (:15) - :$47

*We provide other services at the practice such as Health Coaching, MyoFascial Release/Trauma Therapy, Lymphatic Massage, Cranial Sacrial Therapy, Red Light Therapy and the HOCATT (major detox). Please see our website for a complete list of services and fees.

Please know that, depending on your current level of health, you should expect to have anywhere between 2-5 follow up visits. The fees listed do not include testing, labs or nutrition.

There are several options listed for Dr. Julia Augustyniak, however please note that to receive on-going treatment with Dr. Russell, you must first become established as a new patient in his care.

NOTE: There is a deposit made when you book a new patient visit which is then applied to your total at checkout.

INSURANCE

Our practice does NOT bill insurance, however, we can take FSA's and HSA's and will provide a qualifying IC10 coded bill if requested.

CANCELLATION POLICY

For New Patients, should you need to cancel and move your appointment, please know that we require a firm 48-hours so we may get another patient moved into your time. (For follow-up :30 minute visits, it's a 24-hour cancellation requirement.) If this is not provided, you will forfiet your deposit and ability to reschedule.

PLEASE NOTE: WE DO NOT ACCEPT FLIGHT DELAYS OR CANCELLATIONS AS AN EXCUSE TO MISS AN APPOINTMENT. WE STRONGLY ADVISE THAT YOU DO NOT BOOK ON DAY OF TRAVEL TO AVOID BEING CHARGED - for any appointments made.
We understand some people have to work around other schedules such as a job, school, childcare, travel, etc. However, please be advised that being "on call" or needing to be flexible and canceling your appointment, or not showing up, for any of the above is NOT a valid reason to not adhere to our cancellation policy. Therefore, if you have days that must be flexible with time, please DO NOT SCHEDULE on that day. THIS INCLUDES TRAVEL AND ANY POTENTIAL CANCELLATIONS OR DELAYS.*

Yes, I am clear on the scheduling requirement and my commitment to the appointment I schedule.No, I am not able to commit to the scheduling requirements at this time
I am clear on the requirement noted above under FINANCIALS and I am able to commit to treatment to achieve optimal health.*

Yes, I am clear and able to commit to treatmentNo, I am not able to commit to treatment at this time
How would you like to consult with the doctor?*

Grapevine, Texas Clinic + Virtual100% Virtual
Who else have you worked with?*

Medical DoctorMedical SpecialistFunctional Medicine PractitionerNaturopathic DoctorTraditional Chinese MedicineNutritionistChiropractorHealth CoachNoneOther
How did you hear about Dr. Rodney Russell and the team at the NATURAL HEALING CENTER?*

Patient ReferralPractitioner ReferralFacebookGoogle / Internet SearchWord of MouthOther
If a personal or professional referral, please share their name.
What's the best time(s) to reach you?
Any other brief question(s)?

Brief0/30
NOTE: If you checked NO to any of the above questions, your inquiry will likely be archieved. Please check back and resubmit a form when you are ready for change and able to commit.
Thank you for your information. We will be reaching out to you within 2 business days to discuss your needs and to see if this will be a good fit.
Should be Empty: