Complimentary Consultation Form

Helping You Navigate Healthcare with Confidence

First name

Last name

Phone

Who is this consultation for?

What Brings You Here?

What healthcare challenges are you facing right now? (This helps us understand how to support you)

What Type of Advocacy Support Are You Looking For?

This will help us understand your needs and determine which service or combination of services—diagnostic navigation, care coordination, or holistic exploration—can best support you. (Select all that apply)

What Type of Advocacy Support Are You Looking For? (Select all that apply)

Advocacy During Medical Appointments – Supporting clear and effective communication with your healthcare providers.

Diagnostic Navigation – Guiding you to specialists and diagnostic tests while navigating your healthcare journey.

Second Opinions – Connecting you with additional specialists for further insights and evaluations.

Care Coordination – Organizing appointments, referrals, and communication within your healthcare team.

Symptom Analysis – Analyzing symptoms and connecting you to appropriate resources for further evaluation, if needed.

Medication Reconciliation – Tracking prescription medications, identifying discrepancies, contraindications, or interactions to promote safe and effective use.

Resource Coordination – Connecting you to essential support services, such as nutrition counseling, therapy, and other community resources.

Holistic Exploration –Exploring alternative and complementary approaches such as functional medicine, naturopathy, integrative health, and lifestyle modifications to support your well-being.

Please note: I advocate for you throughout the your healthcare journey, but do not provide medical advice.

NaviCare

Complimentary Consultation Form

What Brings You Here?

What Type of Advocacy Support Are You Looking For?

NaviCare