First Name Last Name Email Cell Number If the wait time is too long, I am interested in seeing one of the other doctors at the clinic who is trained in Dr. Fiona's methods. Yes No Possibly, but please put me on Dr. Fiona's cancellation list What type of help do you need ? Select all that apply hold down "control" to select more than one option Help with Diet Diagnosis Lab Test Review Help with Medications Help with Supplements Ongoing Medical Care Help with Symptoms Why Do You Want to Work with Dr. Fiona? Select all that apply - hold down "control" to select more than one option. I read Dr. Fiona's book I like Dr. Fiona's Blog and methods I've tried everything already I just want a second opinion to go with my current medical care I want to work with someone with a special interest in hormones, thyroid or PCOS What Conditions do You Have? Select All that Apply. - hold down "control" to select more than one option. PCOS/Polycystic Ovary Syndrome Hypothyroidism Hashimoto's Grave's Disease Hyperthyroidism Infertility Perimenopausal Issues Insulin Resistance Diabetes Hyperlipidemia Endometriosis Other Hormonal Issues Irritable Bowel Syndrrome Digestive Issues Other Autoimmune Disease Fibromyalgia Chronic Fatigue Syndrome Food Sensitivities Environmental Sensitivities Joint pain Other (list below) Other conditions not listed above: Dr. Fiona has developed a program "Eating for PCOS" - a detailed online video nutrition course that many are finding success with. Would you like more information on this program? Yes No I don't have PCOS Comments: **Note: In specific cases involving PCOS this program may be recommended by Dr. Fiona along with individual medical treatment. I understand. What is your level of committment to your health? I'm in 100% and I want to get better! I have a few barriers but I'm ready to do everything I can to improve my health. I'm not ready to make changes at this point in time, but that could change in the future. Comments: Submit my Application!