Get Treatment Form

Get Treatment
After you fill out this form, we will be reaching out to you to see if you qualify for care and if we are a good fit to work together on your health!

DO NOT FILL OUT THIS FORM if you:
- You aren't looking for an alternative treatment method
- You aren't in, around, or traveling to the Las Vegas area
- You are looking for only testing
- Are looking for a primary care physician (We aren't PCP)
What's Your Name? *

First Name Last Name
What's the number you want us to text? *
Please enter a valid phone number.
What's Your Best Email? *
We hate spam email, so we won't send you any :)
Where are you from? *

Henderson/Las Vegas Northern Nevada Out Of State Other
What is your current diagnosis? (select all that apply) *

Multiple Sclerosis Hashimotos Infertility Mold Toxicity/Biotoxin Illness Lupus Gut Issues (IBS, Crohns, Ulcerative Colitis) Unsure/Undiagnosed Other
Should be Empty: