Priority Waitlist Application

Thank you for your interest in working with Good Doctors.

Because we intentionally maintain a limited patient roster, patient openings become available periodically. Our Priority Waitlist allows us to give special consideration to referrals, former patients, members of our affiliate program, and individuals with time-sensitive health concerns.

Please complete the form below to be considered for our Priority Waitlist, receive more information about our program, and be notified when an opening becomes available. Submitting this application does not guarantee acceptance and carries no obligation to join our practice if an opening is offered.

First Name

Last Name

Phone *

Email *

Date of birth

City

State

How Were You Referred To Us?

Who Referred You to Good Doctors?

What Are Your Primary Health Goals or Concerns? *

By checking this box, I consent to receive non-marketing text messages from Good Doctors about the program and availability. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive messages and updates among others, from Good Doctors at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.