Appointment Form - Advanced Medical & Weight Loss Center

Imagine feeling your best and staying that way—ready to start?

Addressing the root cause to bring back your energy and balance hormones.

Ready to feel like yourself again?

Thank you for taking the time to answer the questions as thoroughly as possible. Getting to know you helps us provide the best possible recommendations, to help you decide if our programs are right for you.

Our goal is to deliver the highest level of service and to exceed your expectations.

We look forward to getting to know you and helping you get back to feeling your best again!

Request for Advanced Root Cause Reset Consultation

Please fill out the details on this form and a team member will contact you to schedule your appointment. Same day appointments may be available - for fastest response, please submit this form then call or text our office at (770) 467-3975.

Full Name*

Email*

Phone*

Date of Birth*

Have you worked with a functional medicine provider before?*

Yes

What are your main health concerns?*

Medical weight loss

Hormonal concerns related to periods, mood, libido

Hormonal concerns related to energy, metabolism, weight gain

Brain fog, poor memory, difficulty concentrating

Fatigue or sleep issues

Gut health, digestion

I would like to optimize my overall wellness

What resouces are ready to dedicate towarards your improving your health?*

Insurance only

A few thousand to get this resolved

Whatever is needed, health is priceless

Are you willing to take actionable steps and follow a tailored plan to achieve your health goals? *

Yes, I'm ready to take action

Maybe, I need more information

No, I'm not ready yet

What are you looking for most in a health care provider? (choose all that apply)*

Listens to me

Looks at the big picture (holistic approach)

Collaborates with me to help me make the best health decisions for my circumstances

Looks for the root causes of my medical problems instead of just addressing my symptoms

Do you have any questions that you want to be sure we address when we speak?*

I acknowledge:*

Advanced Medical WLC does not bill insurance directly. You may use an HSA or FSA for payment. Insurance may cover some bloodwork ordered through the clinic, but not all services are covered.

Please verify your request.*