Contact Young Foundational Health

Thank you for your interest in booking a New Patient appointment with Alex after hearing about us on Joy FM. Please fill out the below form. All fields are required. Right now you will be put on a waiting list to book an appointment as Alex is currently booking in June. We will contact you as soon as we resume booking for her.
Full Legal Name:
Please type your full name.

Address:
Please include your address.

City:
Please enter your city.

State:
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 want to see Alex)
Please let us know why you would like to schedule an appointment with Alex.

E-mail:
Invalid email address.

Insurance Provider*:
Please include your insurance provider.

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

Are you interested in an in-person visit or a telemedicine appointment?
Please select an appointment type.

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