contact | MDSeeligv3.0

First Name

Last Name

Date of Birth required

Phone

What Brings You Here

What prompted you to start exploring a concierge practice right now?

If you could change a few things about your medical care experience, what would you want to be different?

How would you describe your overall health?

Do you have any ongoing or chronic conditions we should know about?

How important are lifestyle approaches such as nutrition, sleep, movement, and stress management to you?

Are you generally open to making gradual health-related changes over time?

Have you ever participated in a concierge or direct primary care practice before?

What questions do you have about the membership model?

How did you hear about the practice?

Is there anything else you’d like us to know before we speak?

We will reach out to you to set up a meet and greet appointment.