Prospective Patient Questionnaire

Once we get this completed form back from you, if Dr. Gina feels it is a good fit, clinically, we will schedule you for a 20 min free phone consult with Dr. Gina where Dr. Gina and you will become acquainted and go over what it is you are seeking support for. She will then explain the proposed plan of action and what the next steps will be to get your treatment process going.

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After submitting, you will soon receive a confirmation email and we will email you to schedule your Free 20 min tele-consult with Dr. Gina.  If Dr. Gina feels you both are not an optimal clinical fit, she will then provide you with referrals for other clinicians better clinically matched for your specific health care needs.

 

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Disclaimer:  The information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is intended to provide prospective patients with education, but does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. Dr. Gina Mortellaro-Gomez, Healing Traditions Integrated Wellness, LLC shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. By visiting this site you agree to the foregoing terms and conditions, which may from time to time be changed or supplemented. If you do not agree to the foregoing terms and conditions, you should not enter this site.