Griffis Grove Health | SimplePractice

Griffis Grove Health Send Message

Who would be receiving care?

Someone else

Your info

First name

Last name

Phone

Date of birth

Gender

State

Select the state you live in

Reason for care

What is the reason for seeking care?

Primary Care/General Health Weight Management/Metabolic Health Women's Health Hormone Concerns Preventive Care/Wellness Lab Review Medication Management Men's Health Other

Client Preferences

Is there anything that the practitioner needs to know?

For example: what you'd like to focus on, insurance or payment questions, etc.

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How did you hear about Griffis Grove?

Instagram TikTok Google Friend/Family Existing patient Other

Administrative

What state will you be physically located in during your appointment?

CO, KY, TX, FL etc

This form is not intended for urgent or emergency medical concerns. If you are experiencing a medical emergency, call 911 or seek emergency medical care.

I understand

Billing & Payment

Are you aware that Griffis Grove Health Collective is a cash-pay practice?

I understand that submitting an appointment request does not guarantee an appointment and that applicable fees will be discussed prior to establishing care.

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.