Love the Way You Feel!

Request a free discovery call with our Patient Coordinator to learn how we help people just like you.

Application For Free 30-Minute Discovery Call With One of Our Team Members

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

Our goal is to deliver the highest level of service. To exceed your expectations, it is important that we work with people who we can build a relationship with and who are the right fit for our practice.

We look forward to getting to know you and helping you Love the Way You Feel!

Prospective Patients Outside of North Carolina

In order for us to abide by state law and provide the most personalized care possible, we require that all patients have a minimum of one in-person visit annually.

Charlotte Arboretum Office:

Monday – Wednesday: 8:30am- 4:30pm

Thursday: 10:30am- 4:30pm

Friday: 8:30am- 3pm

Belmont Office:

Tuesday-Thursday: 8:30am- 4:30pm

Full Name*

Email*

Phone*

On a scale of 1-10 (1 being "not at all", 5 being "somewhat" and 10 being "I'm 100% ready!"), how ready are you to commit and make the necessary changes to achieve your goals?

How did you hear about us?

If referred to Signature Wellness, by who?

What are the specific health challenges you are seeking treatment & wellness care for?

If you could wake up tomorrow without these symptoms, how would your life be different?

What are your BIGGEST obstacles to achieving your health goals?

Financial

Time- Too busy

Lack of Knowledge

Too Tired

Don't Know How to Exercise for Optimal Health

Don't Know How to Cook

Current medical treatment is not working well

Other- Please elaborate

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 cause of my medical problems, instead of just addressing my symptoms

I understand Signature Wellness is not contracted with any health insurance company.

Yes, I understand that Signature Wellness is not contracted with any health insurance companies.

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

We have more patients apply than we can accommodate. Why do you feel like you are a great fit to work with us?

Please verify your request*