Functional Medicine Discovery Call Questionnaire

Functional Medicine

Please fill the form below to schedule a complimentary discovery call with Dr. Christie

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Name

Layout

Zip Code

Please list the referral name below (if applicable)

Phone

How did you hear about my services? (choose one)

What top 3 medical struggles are you seeking help for?

Functional Medicine treatment plans require consistent participation. How motivated are you to work hard on yourself to feel better?

This is a high tech, high touch medical practice. People must be comfortable using computers. Please check all that apply for you.

I check email regularly
I use social media
I have enrolled in an online course before
I have been in a Zoom meeting
I do not use computers often and I prefer not to

I have the financial resources available to make an investment in my health (up to $3500.00 for the first 6 months, after that pricing is reduced to $297.00 per month).

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.