Your Intake Form
Your Intake Form
Here is our intake form. We tried our best to keep is short and sweet... we hate filling out forms also! If we don't get some information it can be a pain for us :) Of course all data is on Secure Servers and we never release any information of any sort to anyone, ever. Just provide the information you feel comfortable providing, nothing is required. Please put your preferred first and last name in the boxes below.
Please enter your best contact phone number, preferably a text number.
Please enter your best contact phone number, preferably a text number.
Where should we send appointment reminders?
Address
Address
What is the best time and day for a visit? (phoenix, san francisco, and manhattan are full practices/no new patients).
First visit price choice.
Please pick your return visit option
Everyone is treated differently here because everyone is different. We hate pointless procedures. There are no preliminary visits with office staff, and no lengthy forms to fill out. Mostly because I resented doing that when I was sick. I find there is a certain person that has the best chance of getting better with what we do, no matter what the condition. A strong desire to not live their life by the rules and limitations of conventional treatment. A lighthearted approach and desire to spend a little time and money to solve their problem. Extra points if you make us laugh :)

You can get practice updates by entering your email on the main page.
If you want to come to the January talk you need to register from the main page.