Direct Primary Care Application

Please fill out the following questions in order to help us best serve you.
Name
Email
Are you a current patient of East to West Acupuncture?
Do you currently have a primary medical care provider?
What service are you interested in?
Select all that apply.
Which services would you like your primary care practitioner to provide?
Select all that apply.
This service is designed to provide you with primary care without the hassle of insurance. Are you open to continuing?
This field is for validation purposes and should be left unchanged.