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1
What is your biggest health priority right now?
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Finding a long-term solution to wellness concerns & getting back to feeling like myself again.
Managing my symptoms as they come up but not necessarily looking for a deeper solution right now.
I’m just curious and exploring different options, not sure if I need treatment for anything.
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2
What matters most to you when it comes to your health and well-being?
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A provider who takes the time to understand me and offers a comprehensive, personalized approach.
Quick treatments focused on immediate relief rather than long-term care.
Low cost and insurance coverage matter most to me.
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3
How open are you to acupuncture and other holistic treatments?
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I'm totally bought in.
I'm open minded, but not sure. Let's discuss!
I'm skeptical & don't know if acupuncture could ever work for me.
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4
We've chosen to operate out-of-network for the benefit of our patients and sustainability of our practice. Does that work for you?
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Yes! I value the individual attention & flexibility this model provides.
I’m open to it... I’d like to understand more about how it works!
I prefer to stick with in-network providers for cost and insurance reasons.
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5
What is your email?
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example@example.com
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6
What is your cell phone number?
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Area Code
Phone Number
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7
Last Question! What is your name?
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First Name
Last Name
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