New Client Appointment Form
Please be aware that Naturopathic Medicine is not covered by insurance companies
Click here to learn more
Thank you very much for contacting us! We really look forward to meeting you and our scheduling assistant, Rachel, will be contacting you shortly to set up your appointment.
There was an error submitting the form.
New Client Appointment Form
Name
Adresss
Email Address:
Phone Number(s)
Reason for your appointment
Best Time to Reach You
Morning
Afternoon
Evening
Best Day for an Appointment with Dr. Valerie Nelson
Tuesday Afternoon
Tuesday Evening
Thursday Afternoon
Thursday Evening
Saturday Afternoon
Saturday Evening
Services that you are interested in
New Client Evaluation
Detoxification Footbath Session
Food Allergy Testing
Customized Emotional Support Formula
How Did You Hear About Us?
Web Search
Word FM 101.5 - BizBurgh Talk Show
Brochure or Business Card
Newsletter Article
WPIT - AM Radio
Other
Friend
If Referred by Another Individual, please tell us who
Heard about us through another source, please explain
I prefer to be contacted by:
Phone
Email
Either phone or email is fine
Home
|
Appt. - New Clients
|
Appt- Existing Client
|
Appt.- Phone
|
Dr. Val on Radio
|
***********
|
Client Reviews
|
About Dr. Val
|
Pricing & Services
|
Footbaths
|
Footbath - Hoax?
|
Online Orders
|
EMF Jewelry
|
Client Testimonies
|
Pet Testimonies
|
Naturopathy
|
Vitamins & Minerals
|
Hours & Directions
|
Newsletters - Past
|
Homeopathy
|
Newsletters
|
Questions for Dr. Val
|
Contact us
Website
provided by
Vistaprint
