New Patient Application

1. Contact Information:(Required)

First Name Last Name

Email(Required)

Phone(Required)

Age(Required)

Date(Required)

MM slash DD slash YYYY

2. What are your top 2-3 health concerns or goals right now?*(Required)

3. How have you already tried to improve your symptoms?*(Required)

4. Why are you seeking a more personalized or holistic approach now?*(Required)

5. Are you ready to invest time and energy into your health over the next 3 months?*(Required)

Yes, I’m ready now

Maybe, I’m still exploring

Not sure yet

6. Are you open to out-of-pocket care (not insurance-based) if the value feels right for you?*(Required)

Yes

Not sure

7. Before We Begin(Required)

Arcara Access focuses on optimizing hormones and longevity safely and effectively.
Please confirm the following:

I’m up to date with my routine GYN care (Pap smear and mammogram).

I’m not currently being treated for cancer, serious heart, liver, or kidney problems, autoimmune disease, or any condition that needs ongoing specialist care.

I do not have fibroids, endometriosis, abnormal uterine bleeding, or other gynecologic issues that require imaging or specialist care.

I understand Arcara Access provides hormone and longevity care, not gynecologic management or diagnostic imaging.

8. How did you hear about Arcara Access?(Required)

Instagram

Facebook

Google or Internet Search

YouTube

ArcaraAccess.com Blog or Article

Referral from a Friend or Family Member

Referral from a Provider or Therapist

Podcast or Interview

Email Newsletter

Other

Please specify:(Required)

617-431-6140
Info@arcaraaccess.com

Boston, MA
Westborough, MA 

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