Email Sign-Up - Journey Well MD

Patient Name

First

Last

Email Address for List-Serve Updates

Phone Number (optional)

opening when practice

How can this future practice support you?

Please sign me up for the list-serve so I can be the first to know when the practice is opening and be provided with the opportunity to schedule an appointment

Yes, sign me up for the list-serve and notify me when the practice is opening
No, I do not want to be on the list-serve at this time

Preferred way to be contacted when the practice is opening and providing the opportunity to schedule an appointment

Email – be the first to know when the practice is opening and when I can schedule an appointment
Phone call about when the practice is opening and how to schedule an appointment
Text message about when the practice is opening and appointment scheduling opportunities