Discovery Call Request Form
Are you new to naturopathic health? Or perhaps you're looking to explore natural wellness solutions tailored to your needs? Our 10-minute Discovery Call with Nurse Navigator is the perfect first step. Please give us a little more information about yourself so that we can get you scheduled as soon as we are able.
Client/Patient Information
Name of patient
*
First Name
Last Name
Current age of patient:
*
If patient is a minor, please give us the name of their primary caregiver/guardian for contacting to schedule:
Contact Information
A phone number and email address are required for our staff to be able to contact you to book.
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
If you choose to move forward with booking an appointment with Dr. Danielle after this initial Discovery Call with our nurse, would you want to see Dr. Danielle in-person in Sonoma, California or via telehealth?
*
In-person in Sonoma, California
Virtually via telemedicine, if possible
Either option works for me
If requesting an initial telemedicine visit where do you plan on being located during the time of your appointment:
*
California
Montana
In the US in a state other than California or Montana
I am not requesting a telemedicine visit, and am requesting an in-person visit.
Please select the naturopathic services you are interested in:
Comprehensive Naturopathic Initial Consultation (up to 60 minutes)
Weight Management Consultation (<25 minutes)
I would like to go over diet and supplement recommendations for general wellness
I don't know which service
Other (please tell us below):
Special Requests or Preferences
Policies to Review
Even though a credit card is not required prior to scheduling a Discovery Call with our nurse navigator, please review and agree to the policies, should you want to book an initial consultation with Dr. Danielle Schwaderer Kettler in the future. Please review Dr. Danielle's cancellation policy and why we require a credit card to secure booking services for Dr. Danielle Schwaderer Kettler. If you agree to the policies outlined below, please sign and submit the form. If you do not agree to these policies, stop here and no submission of the form is necessary. Thank you for your understanding.
Cancellation and Credit Card Policies:
Services scheduled with Dr. Danielle Schwaderer Kettler require 24 hours notice for any cancellations or changes to your naturopathic appointment. Patients who late-cancel by providing less than 24 hours notice to cancel or reschedule will be charged a $50 late-cancellation fee. Patients who fail to show up to their naturopathic visit and do not notify our office prior to their scheduled service will be charged a no-show fee which is equivalent to the fee for the booked service. Sonoma Roots requires that you put a card on file to reserve your appointment (all appointment types other than Discovery Calls and Nutrient Injections) and is only used for IV Memberships, services that are provided virtually or appointments at Sonoma Roots that are canceled or rescheduled with less than a 24-hour notice, as outlined in our Cancellation Policy. If you have an in-person naturopathic consultation at Sonoma Roots, you will be asked if you would like to be billed for the service using your card on file in this scheduling system, or if you would like to be charged out on our register, where we can combine the service rendered with products purchased at Sonoma Roots. Our register in-office does not communicate with this scheduling system.
I have read and agree with the Cancellation and Credit Card Policies as described above.
Submit
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