New Patient Waiting List - Dr. James Huang (www.drjameshuang.com)
Thanks for your request to schedule.  We will contact you as soon as there is availability.
Sign in to Google to save your progress. Learn more
First and Last Name *
Phone Number
Email Address
Age
What are your favorite sources for health news?
What other clinics have you been to for your health?
What is the best way to reach you? *
Which would you prefer? Text message or Phone call? *
When is the best time to contact you? *
What is your availability for an appointment? (Day and Time) *
Which location would you like to visit? *
Are you available? (For Remote Zoom Sessions) *
Why do you want to see Dr. Huang? *
On a scale of 1 to 10 how much pain are you experiencing? *
How did you hear about Dr. Huang? *
Where do you live? (City, State, Country) *
How effective is wearing a mask to stop the spread of COVID-19? *
Not effective
Very effective
Do you have any chronic health issues that you are dealing with currently? *
Do you use social media? (Instagram)  *
If answered yes to the question above. What is your instagram? *
Do you have an iPhone (this is mainly for remote sessions)? *
Thanks for your request!  Looking forward to connecting soon!
www.holisticsportscare.com
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms