Dr. Alexis Shields' client application

There was an error on your page. Please correct any required fields and submit again. Go to the first error
Dr. Alexis Shields' client application
1. Contact information
4. Have you ever participated in concierge medicine or consulted with a doctor virtually?
Concierge medicine is a relationship between a patient and a physician in which the patient pays an annual fee or retainer. 
  *This question is required.
7. Do you subscribe to any fitness, nutrition, or health-based services?
8. Do you currently have a general physician or family doctor? *This question is required.
9. Do you have easy access to obtaining blood work and medical testing? *This question is required.
10. Have you had a complete blood work-up in the past 12 months? *This question is required.
11. How important is your health to you? *This question is required.
13. How easy is it for you to implement changes to your diet and lifestyle? *This question is required.
15. Drag and drop the following statements in order of the most important to you (top) to the least important (bottom). *This question is required.
Drag items from the left-hand list into the right-hand list to order them.
18. Do you currently have financial resources that you can dedicate toward your health?
19. If cost is a primary concern, would you be interested in a discounted nutritional consultation with one of Dr. Alexis' trusted health consultants? 
20. Which type of consultation package are you most interested in? *This question is required.