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New Patient Application

Interested in working with Dr. Sara? Please fill out this application to get started.

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Question 1 of 9

Your Contact Information:
 Please provide your Name, phone number, and e-mail address so someone from the office can contact you once your application has been reviewed.

(Please look for communications in your SPAM folder)

Question 2 of 9

What the primary reason for seeking consultation with Dr.Sara?

Question 3 of 9

How long has this topic of concern been on your mind?

A

Less than a month

B

Less than 6 months

C

6 mos- 1 yr

D

More than 1 yr

Question 4 of 9

What have you already tried? (Treatments, programs, mindset work, lifestyle changes, etc.) What helped and what didn’t?

Question 5 of 9

Which option best describes the role you see Dr. Sara playing in your care?

A

I want in-person, hands-on therapy at Dr. Sara's clinic in Arizona

B

I want virtual coaching, guidance, accountability & transformation support

C

I'm not sure yet

Question 6 of 9

If we were successful working together, what would “better” look like for you in the next 3–6 months?

Question 7 of 9

How motivated are you to make real changes in your life that will contribute to your success?

A

Not motivated at this time

B

Somewhat motivated

C

Moderately motivated, I'm ready to step it up

D

Highly motivated, I'll do whatever it takes

Question 8 of 9

How did you hear about Dr. Sara & Advantage Body Solutions?

Question 9 of 9

Please indicate below that you are aware that Dr. Sara Asadoorian and Advantage Body Solutions are cash-based fee-for service practices and do not accept insurance.  

A

I am aware.

Confirm and Submit