Jennings Health | Family Application

Jennings Health | Family Application

Thank you for your interest in Jennings Health. We are a small, dedicated practice that accepts only whole families — both children and their parents — for integrative, preventive, and personalized care. To ensure your family’s values align with ours, please complete the application for your entire family.
Where did you hear about us?*

Database: Dr. Green Mom Medical Freedom Healthcare ProvidersDatabase: Just the InsertsDatabase: The Institute for Functional MedicineFamily member or friend (who is already a patient of Jennings Health!)Referral from another practitionerSearch engineSocial mediaTransfer: our family was under Stef's care at Sterling Family Practice
Referred by (family, friend, practitioner)

First NameLast Name
Family Information

We only welcome whole families; every child must be registered with an adult who also intends to join the practice.
Please list all family members who intend to join Jennings Health (including expected babies). Jennings Health is a whole-family practice; both children and adults must be included on the family application.*
Primary Contact*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Engagement and Commitment
In your family, do both Mom and Dad live together in the same household with their child(ren) and actively support a proactive, integrative approach to health, including minimizing medication use and prioritizing natural, preventive care?*

YesNo
Health Philosophy
Describe your family’s core health values. How does Jennings Health's perspective align with your family’s approach to health?*
We most enjoy partnering with families who align with and embrace the "Make America Healthy Again" mindset. We’re looking for families who share our deep commitment to holistic, integrative, and preventive healthcare.
What motivates you to pursue a more natural, preventive approach?*
Are you comfortable adopting new habits that may require commitment, patience, and lifestyle changes? Are you looking for a provider to partner with you in health education and wellness exploration?
How does your family approach daily lifestyle choices related to health?*
Do you prioritize organic or locally-sourced foods? How important is it to reduce environmental exposures, such as from pesticides or plastics? Would you say your family aims for prevention first rather than “quick fixes”?(Examples are helpful!)
In your family’s experience, what role should medications play in healthcare?*
Describe any alternative methods or lifestyle adjustments you prefer before considering medications. Are you open to exploring natural remedies and lifestyle-based therapies as first steps?
Vaccination Preferences

Understanding your vaccination approach helps us ensure our care is a good fit for your family.
Jennings Health supports families in making informed choices about vaccines. For your child(ren), which of the following best describes your current plan?*

We are undecided / seeking guidance.We do not plan to vaccinate our child(ren).We plan to give some vaccines but not all.We plan to follow the CDC or AAP vaccine schedule.Other
Additional Information
Are there any specific health challenges or goals that bring you to Jennings Health?*
This will help us understand your family’s health journey and goals within a holistic framework.
Is there anything else you would like us to know?
We value transparency and want to ensure we can provide the best possible support aligned with our practice philosophy.
Acknowledgements
I acknowledge that due to Jennings Health's small patient panel size and the high cost of vaccines, Jennings Health does not stock or administer vaccines.*

Yes, I acknowledge that Jennings Health does not administer vaccines.
I acknowledge that Jennings Health is an out-of-network provider for all insurance carriers and does not accept insurance for payment. Jennings Health will not communicate with your insurance carrier.*

Yes, I acknowledge that Jennings Health does not accept or communicate with insurance.
I acknowledge that payment for each visit or service at Jennings Health is due at the time of BOOKING. Accepted payment methods include credit, debit, HSA, or FSA debit card.*

Yes, I acknowledge that payment to Jennings Health is due at the time of BOOKING.
Thank you for your interest in Jennings Health!

Please note: submitting an application does not automatically place your family on a waitlist. Each application is carefully reviewed, and we cannot guarantee acceptance or a specific response timeframe.

Families are accepted on a rolling basis. If your family is selected, we will reach out via text message to discuss next steps. Timelines vary depending on factors such as the ages of family members, the number of newborns we are welcoming each month, and alignment with our whole-family, integrative care model.

We appreciate your patience as we thoughtfully build our panel of families!
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Jennings Health | Family Application

Family Information

Engagement and Commitment

Health Philosophy

Vaccination Preferences

Additional Information

Acknowledgements