Love the Way You Feel!

Schedule a Free Discovery Call with one of our Patient Care Coordinators.

Schedule Your Free Discovery Call

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 Love the Way You Feel!

Out of State Residents

For us to abide by state law and provide the most personalized care possible, we require all new patients to have a minimum of one in-person visit to establish care.

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?

What are your top areas of concern?

Thyroid

Perimenopause

Menopause

Weight Loss

Men's Health

Hormonal Imbalances

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 - will discuss in call

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

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

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.

To ensure we spend time and attention with all of our patients, we are only able to accept new patients who are ready to transform their health. Are you ready?

Please verify your request*

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