New Practice Member Application

Thank you for taking the time to fill out this application, which will help me understand what your concerns and goals are, so that I can begin to formulate a plan ahead of our first call. Upon approval of your application, I will reach out to you to schedule a 30 minute initial consult, to get you started on your pathway to robust health & fertility. This consultation works like a strategy session - I'll want to hear a bit more about your story so that I can put together the best possible recommendations for you and also answer any questions. At the end of that call, I'll lay out what your custom package would include to help you meet your goals, as well as what your investment would be, payment options, etc.

PLEASE NOTE: This form is not HIPAA compliant, and sending this information does not establish a Doctor-patient/client relationship with Dr. Low.