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New Patient Application
Apply to be a New Patient
First Name
Last Name
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What hormone symptoms or challenges are you seeking help with?
Have you seen any doctors or tried any treatments up to this point? If so, what have you tried?
How committed are you in making the recommended changes?
Have you read through the website, especially the "Let's Work Together" page to familiarize yourself with the process of working together?
Do you have any questions right now?
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Thank you for submitting an application to work with The Hormone Doctor. We have received it and will contact you to let you know either way. Thank you!
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