The purpose of this Potential New Patient Form is to ensure that Dr. Molly can help you with your health concerns, and that your health goals align with her functional medicine practice.
Instructions:
1. This form takes approx. 10 minutes to complete
2. You will have 48 hours to fill in and submit this form once your initial appt. has been booked
3. Press the “Click Here” box below to access your form online
4. Fill in the form online. Make sure to press “Save” and “Submit”
5. Dr. Molly will review your form
6. We will get back to you within 48 hours to either confirm your initial appt. or provide a referral (where feasible)