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Thank you for taking the time to answer the questions as thoroughly as possible. Getting to know you helps us provide the best possible recommendations, to help you decide if our programs are right for you. Our staff will contact you regarding your discovery call once the form has been submitted.

Our goal is to deliver the highest level of service and to exceed your expectations.

We look forward to getting to know you and helping you Love the Way You Feel!

After submitting your information you will be redirected to our scheduling page where you can schedule your FREE discovery call or book an appoinment.

Full Name

Email

Phone

On a scale of 1-10 (1 being "not at all", 5 being "somewhat" and 10 being "I'm 100% ready!"), how ready are you to commit and make the necessary changes to achieve your goals?

How did you hear about us?

If referred to Orchid Womens Health, by who?

What are the specific health challenges you are seeking treatment & wellness care for?

What are your top areas of concern?

Thyroid Perimenopause Menopause Botox/Juvederm Facial Anti-aging Pelvic Health Men's Health Hormonal Imbalances

What are your BIGGEST obstacles to achieving your health goals?

Financial Time - Too busy Lack of Knowledge Too Tired Don't Know How to Exercise for Optimal Health Don't Know How to Cook Current medical treatment is not working well Other - will discuss in call

What are you looking for most in a health care provider? (choose all that apply)

Listens to me Looks at the big picture (holistic approach) Collaborates with me to help me make the best health decisions for my circumstances Looks for the root cause of my medical problems, instead of just addressing my symptoms

Do you have any questions that you want to be sure we address when we speak?