Getting Started

Together we can move mountains

Nicole will be on maternity leave from June 1 , 2023 - October 1, 2023. If you are interested in joining the waitlist for one-on-one clinical work, please submit the form below.

Working with a functional health-care practitioner is deep work that requires your dedication as well as mine.

The philosophy of functional healthcare is to empower you to take an active role in your healing, with the clinician as your expert guide. If you’re ready to take this step to transform your health, please complete the following form to begin the process.

Name

First Name

Last Name

Phone number

What are your most pressing health concerns or goals?

Please list the top 3

Do you have any past or current medical diagnoses?

Please list and indicate duration

What have you tried before? Diets, supplements, treatments, etc.

Was it helpful? Unhelpful? Please describe

If you are seeking fertility support - is your partner able to participate?

Please describe level of involvement and emotional of logistical roadblocks if relevant.

I understand that this work incorporates dietary changes, use of nutritional supplements, and lifestyle modifications relating to sleep/movement/stress/chemical exposure/etc. I am willing to engage in these modifications as recommended.

Please be honest as you evaluate your response.

I understand that our work will be guided by laboratory testing and I am willing to obtain testing as directed by my practitioner.

Please be honest as you evaluate your response.

I understand that this work is not eligible for insurance coverage, but that I may use HSA/FSA funds to pay for clinical services only (not supplements) per my individual insurance plan.

Yes, I understand

I understand that Nicole Ceil is not a medical provider and our work together does not constitute medical care. I understand that Nicole cannot provide CPT or diagnostic codes in relation to our work.

Yes, I understand

Ideal start date

Questions?

Most new clients have a question or two. Feel free to drop them here and we can discuss before scheduling an initial consultation.

Digital signature

I agree I have read and understood the above items.