Discovery Call Form - Oasis Health and Medicine

Schedule a discovery call below with Oasis Health and Medicine

We welcome new patients to our clinic! Please note: We do NOT accept any Medical Insurance Plans including Medicare & Medicaid.

First Name *

Last Name *

Email *

Phone *

Age *

Sex *

How did you hear about us? *

Where are you located? *

Specify which country you are located in: *

Specify which state you are located in: *

What is your main health goal? *

How often does it bother you? *

How long has it been going on? *

What (or who) would prevent you from completing a health-rebuilding program? *

What have you tried so far that has or has not worked? *

What would you like your health to be in 3 months from now? How about 6 months from now? *

What obstacles, challenges, and struggles do you face regarding diet/lifestyle? *

If we were to work together what would you expect to achieve from working with us? *

What provider have you been referred to or are interested in working with? *

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Legal Disclaimer *

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