Form
Pre-Enrollment Questionnaire for Dr. Matthew Hilton
Thank you for answering the questions below. We’d love to learn a little about you and what matters most to your health before you join. Your answers help us prepare for a smoother, more personalized experience.
I consent to Momentum Medicine contacting me about membership and understand this form is not a clinical visit
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I Agree
Are you..
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Interested in transferring primary care to Dr. Matthew Hilton
Interested in a non-member service with Dr. Matthew Hilton
Are you a previous patient of Dr. Matthew Hilton?
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Yes, I was a patient of his at the Zeeland Office
No, I have not seen him before
Since you are a previous patient of Dr. Matthew Hilton, you may
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Directly sign up for a membership
Schedule a virtual meet & greet appointment to learn more about Momentum Medicine, ask questions, and see if a membership is the right fit
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How did you hear about Momentum Medicine?
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Social Media
Word of Mouth/Referral by a friend
Referral by another medical provider
Previous patient of Matthew Hilton, DO
Other
Do you currently have a primary care physician?
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No
Yes, wanting to change
Other
What are your primary health concerns or goals right now?
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Why are you interested in our practice specifically? (Optional)
How would you describe your current experience with healthcare? What works well, and what could be improved? (Optional)
How do you prefer communicating with your doctor for non-urgent matters?
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Phone Calls
Text Messages
Emails
In-Person
Are you willing/able to pay a monthly membership fee and any lab/diagnostic fees not covered by insurance?
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Yes
No
Not sure
Anything else we should know? (Optional)
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Which non-member service are you interested in at this time? *please note that a sports medicine consult is required for all new requests.
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Sports Medicine Consult visit (includes 1 hour consult visit + a 30 minute follow up visit) $200
Single Joint Injection $50
Bilateral Joint Injection $100
Single Ultrasound Joint Injection $100
Single Platelet-Rich Plasma Injection (PRP) Procedure $600
Other
Please include history/details regarding your request
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Name
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First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Reminder
Please be sure to add the contact hello@momentum-med.com to your email list as email responses from us may be going to your SPAM or JUNK folder. Thank you
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