Book A
Discovery Call

Curious to know more about our work and how we help patients just like you? Apply for a discovery call so we can discuss where you are now and share some insights on how you can reach optimal health for your family. Take the first step towards the vibrant life you deserve!

Functional Pediatric Health Assessment

Thank you for your interest in discussing your child’s health with Dr. Nahas. Dr. Nahas strives to provide her patients with the most effective and medically advanced treatments available. In order to assist you better, please complete the brief form below, after submission you’ll be redirected to schedule a 30 min phone or in person consultation.

First Name *

Last Name *

Email *

Best phone number *

Child's Name and Date of Birth *

Hometown/City, State, Country * *

What are the top health concerns that you'd like us to help your child overcome?

Why is this goal important to you, and what is stopping you from accomplishing it?

What treatments have you tried that helped, and which didn't help?

When did the problem 1st start?

What else was going on in your child's life at that time, in terms of stress, travel, or other life events?

Do you consider yourself coachable? *

Do you have a supportive spouse , or friends or family members to support your goals for your child? *

Who else have you worked with? *

Personal Development Coach
Personal Trainer/Health Coach
Naturopathic doctor
Nutritionist/Dietician
Chiropractor
Functional Medicine Doctor
TCM/Accupunture
Medical Specialist
Medical Doctor/Osteopathic Doctor

Considering your child's past treatments, what would you like to improve or do differently moving forward?

Are you willing to do what's necessary to reclaim your child's health? ( This may include dietary modifications, functional lab testing, lifestyle and environmental modifications, etc...) *

No, I am unable to at this time
Yes, I'll do anything for my child

If we can find a root cause solution to help you restore your child's health, are you capable of investing $2000-$5000 over the next 12 months? *

No, I am not able, I have other priorities
Yes, I am ready and able to invest in my child's health

Have you reviewed the Frequently asked questions ( FAQs) and other pages of our website to get familiar with our approach to health *

Yes, I have
No, I haven't yet

Are you willing and able to participate in office appointments, group visit appointments, as well as virtual appointments? *

Yes
No
Maybe

Comment

Take The First Step Today On Your child's

Journey Back To Health

Perhaps you have questions you’d like to ask before you make a decision to become a patient. Our patient coordinator is standing by, happy to answer any questions you have to determine if Covington Pediatrics is right for you. Simply call to speak with our patient coordinator at 770-787-7444.

Book ADiscovery Call

Functional Pediatric Health Assessment

Take The First Step Today On Your child's

Journey Back To Health

Book A
Discovery Call