Become A Patient

How to Become a Patient

To get started in the healing journey, we ask you to fill out the New Patient Inquiry Form and tell us about your health concerns. Once you fill out the form, a patient care coordinator will be in touch with you within a few days to make sure that the care we provide fits your health needs.

They will share more about how we work with patients through the process of “peeling the onion of disease”, they will discuss pricing with you and will match you up with a practitioner that specializes in your needs.

Tell Us a Little Bit More About You

Do you have a local or primary care physician?

Yes No

We require all of our patients to be under the direct care of a local or Primary Care Physician (PCP) who manages day-to-day routine and urgent care.

First Name

Last Name

I am*

The Patient A parent or legal guardian Authorized for involvement in care

Name

Phone Number

Patient Address

Street Address

Functional Medicine is a personalized approach to treating and managing chronic health conditions and achieving optimal living.

To better understand your concerns and unique background, please share up to 3 health concerns that you hope to address by partnering with The UltraWellness Center.

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Become A Patient

How to Become a Patient

Tell Us a Little Bit More About You

Patient Address

Functional Medicine is a personalized approach to treating and managing chronic health conditions and achieving optimal living.

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