New Patient Waitlist
Please complete this form to be added to our waitlist so we can reach out to you to get you scheduled with one of our providers as soon we are able! **of note, we will no longer bill insurance for visits in our office effective 3/2/2026. We’re so grateful for your trust and support during this transition. 💚Our new membership model gives us the chance to do what we’ve always wanted — spend more time with you and truly focus on your health journey.
Name
*
First Name
Last Name
Date Of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Provider you want to schedule with
*
Please Select
Deanna Woodroffe, WHNP-BC
Erynn Gonzales, PA-C
Michelle Sanders, MSN, FNP-C
Miranda Minter, MSN, FNP-C
Jennifer Bienemann, WHNP-BC
Candice Betz, FNP
No Preference
Reason for Visit
*
Do you have any schedule preferences?
*
Submit
Should be Empty: