Apply to Become A Patient At Zuma Wellness.

Welcome! Thank you for your interest in becoming a patient. Please fill out this application. We will be in touch, usually within 2 business days, after we receive your application.

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* 1. A) What are your main health concerns? B) Please list any other health concerns that are part of your health picture?

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* 2. Which areas of your life are negatively impacted by your current health concerns and situation?

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* 3. What treatments have you already tried or done for your main health concerns? Did they help? What were the outcomes?

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* 4. Please complete this basic info about yourself

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* 5. Additional information about you

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* 6. Do you Smoke Cigarettes'?

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* 7. Do you Exercise?

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* 8. Do you Eat Well?

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* 9. How quickly do you expect to be ably to resolve these issues after initiating a treatment plan?

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* 10. How ready and willing are you to make changes to your nutrition and lifestyle, and also take supplements and medications as needed, on behalf of your health?

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* 11. Are you willing to get labwork and tests done if the doctor deems it necessary?

Do you understand that we don't take insurance? Do you also understand that this is often not a one visit/ quick-fix type of medicine and multiple visits may be necessary to resolve your issue(s)? Are you committed to undergoing and able to invest in multiple visits if needed?

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* 12. Are you ready to commit to a series of visits if needed?

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* 13. Are you ready to invest in your health?

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* 14. Do you have any questions/ concerns that you need answered before you are accepted as a patient with us? Or any final comments?

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