Request a 20-Minute Phone Interview Holly Satvika, FNP390A South French Broad AvenueAsheville, NC 28806(828) 761-1776holly@hollysatvika.com Name * First Name Last Name Email * Phone * (###) ### #### Do you live in North Carolina? * Yes, I do No, and I understand that I cannot be your patient Are you interested in care for yourself or for a family member? * Age of potential patient * How did you first hear of my medical practice? * Please briefly describe your symptoms and health concerns * What are your biggest fears, worries, or disappointments related to your health concerns? * What treatments or approaches have you tried, and what were your results? * How ready and willing are you to make changes in your life to improve your health? These may include dietary changes, remediating your home for water damage, swapping out cleaning and hygiene products, stress reduction, and other lifestyle changes. * Do you currently follow a vegan, vegetarian, or other diet that excludes meat? * Yes No If you answered "yes" to the previous question, is there a possibility that you be willing to reintroduce meat? Yes No Do you have any doubts about your ability to heal? If so, please explain. * If we are the right fit to work together, how soon would you ideally like to schedule your first visit with me? * Would you like to receive occasional emails from me with new blog post notifications and updates on my practice? * Yes No Additional Message (Optional) Thank you! You will hear from me within two business days.