Are We a Good Fit?| Essential Health & Wellness PC

Welcome! This short form is designed to help us learn more about you-and help you decide if Essential Health & Wellness PC is the right partner in your health journey.

We offer personalized, integrative women's care rooted in decades of OB/GYN expertise with a focus on lifestyle, nutrition, and root-cause healing.

This is NOT a quick fix. It's a commitment to transformation.

Please complete all questions honestly. It it feels like a match, we'll invite you to schedule a free Discovery Call.

First name

Last name

Email

Phone

What is your main reason for seeking care? (e.g. hormone imbalance, fatigue, PCOS, cycle issues, perimenopause, etc.)

What would you most like to achieve with support from our practice?

Are you ready to invest time, energy and financial resources in your healing process?

Yes - I know I need this

Possibly - I need more information, but I'm open

Not right now - just curious for the future

We are a cash-pay practice. Are you comfortable with this model?

Yes, I understand and am prepared

I'd like to use my HSA/FSA

I'm not sure - need help understanding

No, I need to use insurance

If it feels like a good fit, are you open to scheduling a Discovery Call or Initial Visit within the next 2-4 weeks?

Yes

No

Anything else you'd like us to know?

Date

Month

Day

Year