Contact Young Foundational Health

Thank you for your interest in booking a New Patient Appointment at Young Foundational Health Center.  Please fill out the form below. All fields are required. (only new patients)

Full Legal Name:
Please type your full name.

Please include your address.

Please enter your city.

Please enter your state.

Zip Code:
Please enter your zip code.

Phone Number:
Please enter your phone number.

Date of Birth:
/ / Please enter your date of birth

Chief Complaint: (Why you are coming in)
Please let us know why you would like to schedule an appointment with Alex.

Invalid email address.

Insurance Provider*:
Please include your insurance provider.

*If you don't have insurance, please put self-pay.

If you are coming into our office, please let us know if you have tested positive for COVID at any point in the past 4 weeks?
Please answer yes or no.