Ready for a journey to better health?

 Please fill out the following questions to make your Meet and Greet appointment with Dr. Zia as clarifying as possible!
 You will be sent to the scheduling page after submitting this form. I am excited about the opportunity to meet you and to discuss how our  approach can help you achieve optimal health and wellness.
By signing up for a meet and greet session, you will have the chance to:
  • Meet Dr. Zia
  • Learn more about her  healthcare philosophy and approach
  • Ask any questions you may have about our practice and your health concerns
This session is a wonderful opportunity for you to understand how Natural Elements Medicine can support your journey to better health. I look forward to welcoming you and starting this journey together.
Sign up now for your meet and greet session and take the first step towards a healthier, more balanced life with Natural Elements Medicine!

How did you hear about Natural Elements Medicine/ Dr. Zia?
What are your main health concerns or wellness goals?
What are your expectations for your treatment at Natural Elements Medicine?
Have you previously received any form of naturopathic or holistic treatment? If yes, please describe the treatments, the duration, and the outcomes or benefits you experienced.
Are you currently under the care of any other healthcare providers?
On a scale of 1-10, where would you rate your level of commitment to make lifestyle and dietary changes?
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©Natural Elements Medicine LLC

233 3rd Ave SW
Albany OR 97321
541-791-6537 (ph) - 541-203-7360 (f)