New Patient Screening Form

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NEW patient screen

For prospective patients of Natural Elements Medicine/ Dr. Zia Robles Hernandez
  • Write down what you might expect from this partnership, as well as how you expect out of treatment.
  • Please enter a number from 0 to 10.
  • Please enter a number from 0 to 10.
  • This question is to give me an idea of what approach is best to take, given that I will always offer the most effective (both health and cost-wise) treatments.