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New Patient Request Form
Please allow 3 business days for a response.
First name
Last name
Email
Phone
Birthday
Month
What are you interested in working on? Please select all that apply.
Hormonal imbalances (e.g., PMS, PCOS, perimenopause, menopause)
Menstrual irregularities (e.g., heavy periods, absent periods, cramps)
Thyroid disorders (e.g., hypothyroidism, Hashimoto's thyroiditis)
Infertility and fertility optimization
Adrenal fatigue and chronic stress
Weight management and metabolic health
Gut health issues (e.g., bloating, IBS, leaky gut)
Health optimization
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