Digna Whole Health Prospective Patient Application

Thank you for taking the time to complete this form! We are excited to learn about your goals and how we can help! We will review your submission, and either offer an initial consultation if it seems like it will be a good fit, or notify you if we cannot accept you as a patient at this time.

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Name
What are your primary concerns or symptoms?
Selected Value: 0
How long have you been experiencing these symptoms?
What steps have you taken to address these symptoms?
Are you interested in PERSONALIZED root cause evaluation of your symptoms that may include functional medicine labs, high-quality supplements, significant lifestyle changes, and/or prescriptions for weight loss or hormone replacement?
Are you willing to set goals and challenge previous habits or barriers to achieve better health?
Are you willing to meet monthly for the next 3-6 months?
Please indicate if you meet any of the following
PLEASE NOTE : At this practice we serve patients ages 18-64. We DO NOT bill insurance (You can use your HSA), and we CANNOT accept patients that receive Medicaid or Medicare.
While Dr. Huntington is a Board-Certified Internal Medicine Physician, we DO NOT provide primary care at this practice.

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Digna Whole Health

465 West Elm Avenue
Suite 209
New York, 10001

Questions? Email us.

[email protected]