Shift Functional Medicine

Appointment inquiry

Please fill out this form so we can contact you and schedule an appointment for your initial visit.

(We respect your privacy and will never use your information for any other purpose.)

First and Last Name * Required

Your Email * Required

Date of Birth * Required

Phone Number * Required

Address * Required

Please fill out your full address!

Preferred provider(s) * Required

Christina Richards, MSN, FNP-C

Deb Harding ND

Dr. Marie Agnew DNP, FNP-C, IFMCP

James Southam MSN, FNP-C

Lyndsey Brozyna, Acupuncture

Jennifer Nelson MSN, FNP-C

Paige McAfee MSN, PNP

Sarah Cooneely FNP-C

Insurance Provider (Include Member ID & Group #) * Required

Preferred Days/Times * Required