Is Naturopathic Medicine A Good Fit For You?
Sign in to Google to save your progress. Learn more
Email *
Welcome!

Completing this survey fully and submitting it to us will provide you with a follow-up email from us that includes a link to our secure New Patient Application.  This application is mandatory for any prospective patient at Toledo Naturopathic.  

Dr. Watts reviews each completed application.  If your healthcare concerns and goals are something specific that Dr. Watts can help you with, and you aren’t opposed to being seen several months from now, she will invite you to be on our waiting list.  Otherwise, should your needs be urgent, or if Dr. Watts is aware of another Naturopathic Doctor in Ohio that could address your needs and be a good fit, she will give you that referral information.

Upon submitting your application, you can expect to hear back from us by e-mail within 2 weeks.  Please add our email address to your email address book to ensure the application is delivered to your inbox: survey@toledonaturopathic.com

*Due to health care laws and HIPAA compliance, any patient that is 18 years old or above must complete their own survey and application (ie: a spouse cannot complete an application on behalf of their spouse). If you are completing this on behalf of a minor, please indicate that where applicable, and fill out form questions from the patient's perspective.* 
Check all of the boxes that are true for you. 
If they are not all true, this may give you options on where you could otherwise start in your healthcare journey (Example: If you have yet to see your primary care provider for these concerns it’s best to start there before seeing Dr. Watts).  As the waiting time to be seen as a new patient can be several months, we want to make sure that you can make the most of your time until then.  
1 *
Required
2 (choose one) *
Required
3 *
Required
4 (choose one) *
Required
5 (choose one) *
Required
6 *
Required
7 *
Required
8 *
Required
9 (choose one) *
Required
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Angela Jiniel Marketing & Design VA. Report Abuse