Your Vytal Health Provider

1
New to Functional Medicine?Let us know a little about your experience so far
Please Select
Please Select
I'm new to functional medicine and haven't seen a provider before
I have seen a functional medicine doctor in the past
I have worked with other providers outside of traditional healthcare (Naturopath, Herbalist, Chiropractor etc) but not a functional medicine provider
2
How old are you?We use this information to help match patient with provider.
0-12
12-21
21 - 65
65 +
3
Where are you located?We use this to match you with a provider licensed in your state. It's vital to matching you with a provider. At this time we can only treat patients in the USA.
4
What primary symptoms or health concerns are you experiencing?Our providers have different areas of expertise within Functional Medicine. This will help match you to a doctor with the skills to treat you!
Fatigue
Digestive Issues (bloating, constipation, diarrhea, etc)
Hormonal Imbalances (including thyroid, menopause, PMS, etc)
Fertility
Chronic Pain or Inflammation
Anxiety and/or Depression
Autoimmune condition(s)
Sleep Issues
Weight Management
Dermatology
MCAS, Hypermobility, POTS
Other
5
Which style best describes you?Different approaches work for different people! We can accommodate your preferences in our treatment plans
I want ALL the science and as much information as possible. I am an amateur expert in functional medicine.
Meet me where I am at, I'm new to functional medicine. Slow & steady suits me.
I know what I want to achieve but cannot get there alone. I want my doctor to make personalized recommendations for me based on my goals, and provide the support I will need to reach them.
I want step-by-step bullet point instructions of what I need to do and when. I can take it from there!
I'm not sure! All of the above resonates with me.
Other
6
Our clinic operates on a payment plan basis and doesn't accept insurance directly. We do accept HSA and FSA, and you may be able to get reimbursed if you have 'out-of-network' benefits. Does this work for you?
Yes, this works for me!
I prefer to use my insurance directly
I'm not sure, I need more information
7
Bloodwork is usually covered under insurance and can be drawn at LabCorp or Quest Diagnostics. Will this work for you?
Yes, I can work with that
I prefer another method for bloodwork
I'm not sure, I need more information
8
We are a 100% virtual clinic, and all appointments are conducted via a secure video link. Are you comfortable with virtual appointments?
Yes, virtual appointments work well for me
No, I prefer in-person appointments
9
Our approach requires commitment to a treatment plan that includes diet and lifestyle changes, vitamins & supplements, as well as comprehensive testing. Are you ready to actively participate in this type of treatment plan?
Yes, I am ready to commit to my health journey
I'm not sure, I need more information
At this stage, I prefer a different approach
10
What name should we put on your quiz results?* This field is required.
First Name
Last Name
11
Where can we reach you?* This field is required.We will send you information on how to schedule with your Vytal Health provider! We are not telemarketers and will respect your inbox! Unsubscribe at any time.
example@example.com
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