Prospective Patient Questionnaire

Prospective Patient Questionnaire
Thank you for watching Dr. Kristina's Welcome Video.

(If you haven't had a chance to watch the video, please go back to this page and watch it before completing this questionnaire.)

Please fill out this form to let us know a little more about your goals so we can determine whether our office is a good fit for what you're seeking.

After submitting this form, someone from our office will be in touch with you within 1-3 business days to discuss the next steps.
Today's Date*

MonthDayYear
Date
Your Name*

First NameLast Name
Email*
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Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Please briefly describe the healthcare concerns that have led you to reach out to our office today.
What is it about Lewis Family Natural Health, Dr. Kristina Lewis, or naturopathic medicine in general that most appeals to you?
Have you ever worked with a naturopathic doctor or other kind of holistic practitioner before? Please briefly describe your experience(s).
Naturopathic medicine, as practiced by the doctors at Lewis Family Natural Health, works best when a patient is committed to the process. Rarely is it a "quick fix."

The patients who benefit most from our care are those who are willing to follow the recommendations, commit to the process, maintain regular follow up appointments, and keep an open line of communication.
Are you open to giving the process the time it takes and willing to take the steps necessary to follow through with our plans in order to receive the maximum benefits? If so, please elaborate below. If not, please explain your hesitation so we can discuss potential obstacles to set you up for success.
As with anything in healthcare, there's no guarantee of success in achieving your health goals.

Sometimes health will improve two steps then take one step back before taking two steps forward again. Sometimes one issue will resolve but another will stubbornly remain.

Everyone is different, and the speed and ways in which someone improves varies wildly.
How do you feel about not having any sort of "guarantee" in outcomes?
After the initial New Patient appointments, most patients will have monthly follow-up appointments for at least 3-6 months. Are you generally available on Thursdays, Dr. Kristina's main day for patient visits? Appointments can be held in person, over Zoom, or by phone.
Is there anything else you'd like to let us know?
Thank you for taking the time to share this information with our office! After submitting this form someone from our office will be in touch with the next steps in the next 1-3 business days. In the meantime, please call us with questions at 828-298-4800.
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Prospective Patient Questionnaire

Thank you for taking the time to share this information with our office! After submitting this form someone from our office will be in touch with the next steps in the next 1-3 business days. In the meantime, please call us with questions at 828-298-4800.