Caplan Health Institute

Welcome to the initial phase of your journey with our functional medicine team. This session marks the beginning of your path towards ongoing care and wellness.

During this evaluation consult, you will have the opportunity to engage with one of our functional medicine health advisors. This meeting is a chance for you to inquire about our unique approach to health and wellness, as well as to share your own health concerns and objectives. Our goal is to understand how we can best assist you on your health journey.

At the end of this consult, if we decide we are a good fit, we will outline the next steps in your care plan. This may include enrolling in one of our specialized programs and scheduling an initial consultation with Dr. Caplan. We are committed to guiding you towards optimal health and look forward to partnering with you on this journey.

If you encounter any difficulty scheduling or need assistance, feel free to call or text us at 805-556-7200. We're here to help!

First Name *

Last Name *

Email *

Phone *

State *

Your Age *

I agree to receive SMS messages from Caplan Health Institute for appointment notifications and feedback requests. Message frequency varies. Message and data rates may apply. Text HELP for assistance, or STOP to opt out.

What are the top health concerns that you would like us to help you overcome? *

Considering your current and past treatments, what would you like to improve or do differently moving forward? *

Why is this goal important to you, and what do you think is stopping you from accomplishing it? *

Do you have a supportive spouse or significant other to support your personal goals? *

Yes

Anything else we should know?

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We are here to serve you and our community at the highest level. We take this stuff seriously! We hope you will too!

We ask that you continue with integrity and only make this appointment if you plan to honor your commitment to showing up for this reserved time and have read and understand the statements below.

COMMITMENT TO SHOWING UP *

I understand this time slot is being reserved specifically for me and I am committed to being ready and showing up at the scheduled time.

INVESTMENT FOR CARE *

I understand that moving forward with care will involve out-of-pocket expenses. I acknowledge the approach to care is tailored to each individual, resulting in varying costs. We prioritize financial transparency and will provide a clear, estimated investment for care, considering your financial situation, before proceeding with any services. There is no obligation to proceed with care following this consult.

I AM WILLING TO INVEST IN MY HEALTH (If it is determined that I am a good candidate for care and I decide that the care offered aligns with my health goals, please select the answer that most aligns with your current situation.) *

Yes (I am willing and able to invest in my health)

No (I'm not willing/ able to invest in my health)

INFORMED DECISION-MAKING *

I acknowledge that if there are other individuals (spouse, parent, etc.) involved in making my health or financial decisions, I will ensure they join the consultation to facilitate informed decision-making.