Thank you for your interest in Dr. Elena’s Hormone Potential Therapy™ program. Please fill out the application below, and we will contact you to schedule your complimentary, 15-minute consultation. Note that we do not accept insurance.

We highly encourage you to visit the Hormone Potential Therapy page to review the Hormone Potential Therapy program outline before scheduling a call.

Name

First Name

Last Name

Email Address

How did you hear about us?

What are your 3 primary health goals?

What have you tried to improve your health?

Anything else you want Dr. Elena to know?

I have downloaded the Hormone Potential Therapy program summary

Please do so before trying to schedule a call!

Yes!

Not yet, but I will do so before the 15-minutes call

What is your timeline to get started?

Which services are you interested in?

Hormone health

Gut health

Weight loss

Stress/Anxiety management

Lifestyle

Nutrition

Proactive Health ND is an out-of-network clinic and insurance is not accepted.

I understand Proactive Health ND does not accept insurance