Patient Enrollment Form

Just fill out the form below and we will send you the consent forms and the “Living Matrix” our online medical timeline and questionnaire. The Living Matrix provides valuable information to our practitioners and is the first step to the Functional Medicine process. Once you get that back to us your patient representative will be in touch to help you with the rest of the process. You can always reach your patient representative in case you have a question or need help.

Personal Information



Functional Medicine consultationWeight Loss ProgramsPersonalized Supplementation plansExercise ProgramsNutritional Counseling ServicesHealth and Lifestyle coachingMeal Planning ServicesOther (please specify below)

Thank you!

Need Help or Have Questions?

You can always reach one of our patient representatives to assist you. Just fill out our contact form, and a patient representative will be in touch shortly.

Speak with a Patient Representative