Functional and Integrative Primary Care Membership

Excited About Our Approach?

Let’s Determine If We’re Right for Each Other!

At Living Water Women’s Wellness, we’re committed to providing personalized care tailored to your unique journey. Please take a moment to fill out our prescreening form to help us understand your needs better. Your health and well-being are our top priorities!

Name

Phone Number

What are your primary health goals, and what specific concerns would you like to address through our services?

Have you experienced any particular health challenges or conditions that you feel need attention?

Can you share your past experiences with healthcare providers? What aspects did you find beneficial or unsatisfactory?

Have you faced any challenges in accessing care or getting the support you need from traditional healthcare systems?

What are your expectations regarding communication with your healthcare provider (e.g., response times, methods of communication)?

How important is it for you to have longer appointment times and a personalized care approach?

Are you open to exploring holistic or alternative therapies alongside conventional treatments?

How important is a focus on preventive care and lifestyle modifications in your healthcare journey?

Are you comfortable with the membership fee structure, and do you understand what it covers?

Are you willing to commit to regular check-ins and follow-ups as part of your care plan?

How do you currently manage stress, and are you interested in techniques for nervous system regulation?

Have you explored or practiced any mindfulness, meditation, or self-care techniques in your daily life?

Do you have a support system in place (friends, family, community) to help you in your health journey?

How do you prefer to communicate about your health challenges with your loved ones?

On a scale of 1 to 10, how ready do you feel to make changes to improve your health and well-being?

What barriers do you anticipate facing in achieving your health goals, and how can we support you in overcoming them?

What values are most important to you when it comes to your healthcare?

How do you feel about being part of a community that emphasizes women's health and well-being?

Do you have any specific questions or concerns about our practice or the functional and integrative primary care membership model?

Is there anything else you would like us to know about you that might help us understand your needs better?

CONTACT INFORMATION

Call or Text : 302-514-8008

[email protected]

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Nervous System Regulation Cheat Sheet

Calm your nervous system, and your life will follow. Regulation isn’t just about managing stress—it’s about reclaiming peace, clarity, and your true self in every moment