Application for Free 15 Minute Health Consultation

I'm thrilled to help you honor your own koseli (gifts) by seeing what's possible with your health!  This application is for a 15 minute phone consultation with me, Aimee Spencer, PA-C.  It's the beginning of the enrollment process for my patients.  

During our 15 minute phone consultation, I'll ask specific questions about your symptoms to see if functional medicine is helpful for your case.  If we are a good fit to work together, you'll be invited to make an initial appointment.  If we aren't a good fit, you'll walk away with a personalized email directly from me that helps steer you in the right direction with additional articles, videos and resources to consider!  Win/win!

My functional medicine private practice is very unique and innovative.  It's less of a "doctor's visit" and more of a "guided partnership" to sequence your steps to better health.  Therefore, I only invite those action-takers that are ready to utilize health coaching, private appointments, online classes and videos to help themselves uncover better energy, deeper sleep and improved vitality.

After you complete this form, I will respond within 3-5 business days with the next steps.

Have a wonderful day!
-Aimee Spencer, PA-C
Email *
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First and Last Name *
Phone Number *
I am a resident of: *
What are your concerns that had you schedule this quick 15 minute consult?  *
If those symptoms disappeared, what would you be free to do differently now?  *
What have you tried that has WORKED WELL for you so far?  *
What have you already tried that HASN'T helped?  *
Why do you feel a comprehensive, holistic medical approach may be right for you and why is NOW the right time?  *
Briefly describe any key information that you would like me to know before our call. 
 I do not participate in medical/legal cases like DOT physicals, worker's comp, injury cases or vaccination waivers.  Are you seeking my services for this purpose? *
To stay focused and make the most out of our time together, please check the items that interest you the most: 
Functional Medicine treatment plans require consistent participation. (For example: learning about your body and building new habits around eating, movement, sleep, thinking, etc) HOW MOTIVATED are you to WORK HARD on yourself to feel better? (choose one)
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What's ONE QUESTION that you want to make sure is discussed during your phone Strategy Session? (Is there anything specific you are seeking?)*
Your answer

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How did you hear about my services? (choose one)
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Please list the referral name below (if applicable)
Please give a general time of day that would work best for you for our Strategy Session.
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