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Naturopathic Care
Fertility & Preconception
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About
Naturopathic Care
Fertility & Preconception
Blog
Connect
Whole Body Healthcare for Your Family
book an appointment
Sliding Scale Interest Form
Please complete the form below. I will review and get back to you.
Name
*
First Name
Last Name
Email
*
What financial barriers are currently standing in the way?
*
What health concerns are present for you?
*
What is your goal in working together & how would you assess improvement?
*
Are you willing and ready to invest in your health?
*
Yes, absolutely!
Yes, but I have questions.
I am not sure.
HOw bothersome are your current health concerns?
*
They affect me daily.
They affect me weekly.
They affect me here and there.
What are you willing or able to put towards treatment recommendations?
*
$60+ monthly
$30-60 monthly
< $30 monthly
Are you open to spacing out follow up visits to best support your finances & treatment process?
*
Yes, absolutely.
Yes, I think so.
I am not sure.
Are you interested in chatting more over video call?
*
Yes, definitely!
No thanks.
Thank you! I will review this and get back to you!
