Concierge Application
Welcome to my application. I am so excited to get to know you better. My name is Dr. Ginger Sweetan and I am known by my clients, patients, and colleagues as the LONGEVITY doctor.

My vision is to help you prevent age associated illness, stop the progression disEASE, and empower you with the tools you need to age in reverse!

These questions below will help me determine if I am the best doctor for you and if you are an ideal candidate for what I can help with! 

Before we get started, I want to let you know that this program is not for you if you are someone who is:
  1. Navigating a potentially life threatening and/or debilitating disease. We could work together in the future, but not at this time.
  2. Looking for insurance based treatment. What I do is concierge medicine that will increase your longevity! What I teach and practice WORKS but I do not let insurance dictate best treatment practices.
Although I am trained in primary care, and have a special place in my heart for those patients I have worked with there,  I do not currently act in a primary care capacity and I require all program participants to have a primary care provider.

Please take time on this application and provide detailed, thoughtful answers as this will allow me to best determine if we are potentially a good match. I am looking forward to getting to know you.  Live Long, Live Lively!

Warmly,
Dr. Sweetan, ND
The Longevity Dr.

*Licensed as Virginia Sweetan (CA 1114, UT 13037729-7100)
Email *
Full Name *
Age *
Phone Number *
Address? *
Profession *
Have you worked with a concierge doctor before? *
If you answered yes above, please describe your experience. If no, please type n/a. *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy