832-422-7211

Thanks For Scheduling Your Appointment

In order for us to best prepare for your appointment, please complete the brief survey below

Do you currently have diabetes or blood sugar irregularities?? *

Yes

No

Do you currently take medications for peripheral neuropathy such as Metformin, Semaglutide, Insulin or other diabetic medication? *

Yes

No

Do the doctors know what caused your diabetes? *

Yes

No

How committed are you to finding a natural solution for your diabetes TODAY? *

Very Committed

Somewhat Committed

Neutral

Not ready to commit

PLEASE ACKNOWLEDGE THE FOLLOWING STATEMENT: "I will NOT miss my appointment once it is scheduled because I respect your time and I understand it's not fair for others who have scheduled in my place if I don't show up." *

Yes

No

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