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2024 Clinic Patient Survey

Please fill out this brief survey, so we can serve you better!

Privacy Guarantee: We will never share your information with anyone

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Question 1 of 10

What medical conditions would you like to learn how to treat, without surgery?

(Select all that apply)
A

Spine or Joint Pain

B

Energy and Hormone Imbalance

C

Sexual Health Problems - for Men or Women

D

Longevity and Prevention

E

Face and Body Aesthetics

F

None of the above

Question 2 of 10

Which of the following TREATMENTS for SPINE OR JOINT PAIN are you interested to learn more about? 

(Select all that apply)
A

PLATELET RICH PLASMA (PRP) - Using concentrated growth factors isolated from your own blood, PRP therapy can promote and accelerate healing in tendons, acute injuries, and arthritic joints.

B

STEM CELL or Q-CELL THERAPY - By transplanting isolated, concentrated cells from your own blood, we can painlessly repair and replaced damaged tissue to improve mobility and function.

C

ACOUSTIC WAVE or SHOCKWAVE THERAPY - Using acoustic sound waves, Shockwave therapy promotes cell regeneration to provide fast, non-invasive pain relief, restored mobility, and faster recoveries.

D

IV HYDRATION - When dehydration causes troublesome joints to flare up unexpectedly, IV Hydration provides painless relief without stressing your digestive system.

E

PEPTIDE THERAPY - Treat rheumatoid arthritis and other chronic inflammatory diseases with peptide therapy, which uses specific proteins to control the body's autoimmune response

F

NONE of the above

Question 3 of 10

Which of the following TREATMENTS for SEXUAL HEALTH are you interested to learn more about?

(Select all that apply)
A

For WOMEN - INCREASE INTIMACY and REDUCE INCONTINENCE with O-SHOT® - The O-Shot® is a revolutionary non-surgical procedure for women to significantly improve sexual confidence, sexual health, and stress urinary incontinence.

B

For MEN - INCREASE PERFORMANCE and TREAT ED - (Erectile Dysfunction) with P-SHOT® - The P-Shot® can improve erectile function, enhance sensitivity, boost confidence, and even increase penis size--in one 30-minute procedure.

C

RESTORE BALANCE with HORMONE OPTIMIZATION - Hormone imbalances in men and women can decrease sensation and desire, negatively impact sexual performance, disrupt sexual function—all of which can be improved with custom-compounded bio-identical hormone pellets.

D

PEPTIDE THERAPY for SEXUAL HEALTH - In addition to helping fitness goals, peptide medicine can also increase sexual desire, function, and performance.

E

NONE of the above

Question 4 of 10

Which of the following TREATMENTS for FACE and BODY AESTHETICS are you interested to learn more about?

(Select all that apply)
A

NON-SURGICAL LIFT with VAMPIRE FACELIFT® - The perfect combination of PRP therapy and hyaluronic acid filler, the Vampire FaceLift® gives you smooth, younger-looking skin with improved collagen, and tone.

B

RESTORE YOUR NATURAL BEAUTY with BOTOX® , FILLERS, & KYBELLA - Using the most popular dermal fillers and wrinkle treatments that won’t compromise your natural beauty—or your natural expression.

C

NON-SURGICAL VAMPIRE HAIR RESTORATION - Using the growth factors in your own blood products (PRP), this procedure “wakes up” sleeping hair follicles to restore your natural hairline and hair thickness.

D

NON-SURGICAL LIFT with VAMPIRE BREASTLIFT® - Using PRP and a proprietary injection process, we can regenerate the collagen and connective tissue around the breasts, giving them youthful lift and fullness.

E

WEIGHT LOSS and METABOLISM RESET - This low-impact, 90 Day Weight Loss RESET leverages the power of peptides to help you easily suppress appetite, burn fat, and reset your metabolism and mindset for long-term results - even if you have joint pain and/or can't do cardio.

F

REDUCE BROWN SPOTS and SUN DAMAGE with ALMA LASER - Alma’s light-based, laser and IPL treatments remove the appearance of spots and skin hyper-pigmentation by targeting the melanin in the darkened area and dispersing it.

G

NONE of the above

Question 5 of 10

Which of the following TREATMENTS for ENERGY and HORMONE IMBALANCE are you interested to learn more about?

(Select all that apply)
A

RESET HORMONE IMBALANCE from MENOPAUSE - Menopause can wreak havoc on your bone density and joints. Our bio-identical hormone pellets are custom compounded for your unique physiology.

B

BIOIDENTICAL HORMONE REPLACEMENT THERAPY - (BHRT) - Treat hormone imbalances from low testosterone, to menopause, to thyroid disorders with bio-identical hormones specifically created with your unique physiology in mind.

C

INCREASE ENERGY with PEPTIDE MEDICINE - Lose weight, gain muscle, and reduce recovery time from exercise with a targeted peptide therapy program designed just for your health and fitness goals.

D

IV NUTRITION for MAXIMUM ENERGY - Recover from dehydration, modern toxins, immune challenges, athletic training, and chronic fatigue with IV Nutrition that goes right where you need it most.

E

IV HYDRATION for MAXIMUM PERFORMANCE - Replenish your body with the water and nutrients it needs. Painless and immediate, IV Hydration optimizes joint function, immune performance, and more.

F

NONE of the above

Question 6 of 10

Which of the following TREATMENTS for LONGEVITY and PREVENTION are you interested to learn more about?

(Select all that apply)
A

WEIGHT LOSS and METABOLISM RESET - This low-impact, 90 Day Weight Loss RESET leverages the power of peptides to help you easily suppress appetite, burn fat, and reset your metabolism and mindset for long-term results - even if you have joint pain and/or can't do cardio.

B

IV NUTRITION - Recover from dehydration, modern toxins, immune challenges, athletic training, and chronic fatigue with IV Nutrition that goes right where you need it most.

C

IV HYDRATION - Replenish your body with the water and nutrients it needs to feel better. Painless and immediate, IV Hydration optimizes joint function, immune performance, and more.

D

MEDICAL GRADE SUPPLEMENTS and NUTRACEUTICALS - Give your body the precise vital nutrients it needs to thrive.

E

PEPTIDE MEDICINE for PREVENTATIVE HEALTH - Fight fatigue, low sex drive, and chronic inflammatory diseases with the specific proteins designed to kick your body’s natural healing processes into gear.

F

NONE of the above

Question 7 of 10

What is ONE thing, more than anything else you would LIKE TO LEARN more about from Dr Heather? 

(if nothing, please type NA for Not Applicable)

Question 8 of 10

What is ONE thing, more than anything else, that you APPRECIATE MOST about our service? 

(if nothing, please type NA for Not Applicable)

Question 9 of 10

What ONE thing, more than anything else, that we can we do to IMPROVE OUR SERVICE for you and your family?

(if nothing, please type NA for Not Applicable)

Question 10 of 10

Anything else you would like to share with us? 

(if nothing, please type NA for Not Applicable)

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