FxMedSupport Apollohealth V1

Name(Required)
Gender:(Required)
How did you hear about Apollo Health Clinic & Dr. Sam Madeira?
You agree your health is stable (no hospitalizations in the past year):
You agree that you are currently not undergoing any treatment for cancer:
What are your BIGGEST obstacles to achieving your health goals? (for example, this could include - money, time, lack of knowledge, chronic fatigue, energy, clarity, don't know how to cook your own meals, etc.)
Assuming it is medically necessary: If we can find a root cause solution to help you restore your health and help you achieve your wellness goal(s), are you capable of investing $2,000-$6,000 over the next 3-12 months?
Will you be compliant with getting advanced blood, urine and/or stool testing done?
Are you able to travel to Apollo Health Clinic in downtown Seattle, WA, or Kalispell, MT for at least one face-to-face visit per year with Dr. Madeira?
How much do you know about our clinic?
I understand that Dr. Madeira is licensed in as a Naturopathic Physician and can prescribe with limited prescription abilities, we do not prescribe opiates.
I understand Dr. Sam Madeira is not contracted with any health insurance companies.
If you are NOT the sole financial decision maker please confirm your spouse, significant other, or parent(s), etc. will be on the Discovery Call or at the Meet and Greet visit with you:
I'm looking for:(Required)
Yes, please put me on your waiting list for working with: