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Discovery Call Questionnaire

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1. Briefly Describe Your Health Concerns ?

2. Yes, I am looking to make a long-term commitment to my health and I am committed to taking my health and wellness to the next level.

Yes, I am committed to making changes in my life for my health.
No, I am not committed to making changes in my life for my health.

3. On a scale of 1 to 5 how committed are you to making changes to your health?

1 = (not committed), 5 = (fully committed)

4. I am excited to apply lifestyle skills and I am coachable and teachable.

Yes, I am very excited and coachable.
No, I am not excited and/or coachable.

5. I have the financial resources available to make an investment in my health (up to $3,500.00 for the first 6 months, pricing is reduced after this).

Yes, I can invest in my health.
I can get the financial resources if it means investing into a program to help me reach my goals.
No, I do not have the resources to invest in my health at this time.

6. Are you the final decision maker, in regards to your health and finances? If you need someone else to make the decision with you (ie: spouse, parent), please have them on the call with you

Yes, I can make the final decision or yes my partner will attend the call.
No, I am not the legal decision-maker.

7. How did you hear about Christie MD Functional and Aesthetic Medicine?

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Name *

Email *

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ADDRESS

2191 9th Avenue N
Suite 240
St. Petersburg, FL 33713

CALL US

Tel: 727-220-9080
Fax: 727-933-0294

WRITE TO US

info@christiemdfam.com

BOOK AN APPOINTMENT

Click here to book an appointment with Dr. Heather Christie.

Heather Christie, MD is a board-certified Family Physician who practices Functional and Aesthetic medicine in St. Petersburg, FL. She is also licensed in North Carolina.

Contact Us

2191 9th Avenue N
Suite 240
St. Petersburg, FL 33713

727-220-9080

info@christiemdfam.com

727-933-0294