Follow Up Thank you for filling out our form. We respect your privacy and will never share your information with anyone. To fully evaluate your individual circumstance, we would like you to tell us a little more about the symptoms you are experiencing. Please check all that apply to you: Nerve Pain Low Energy High A1c High blood sugar High blood pressure Obesity Vision loss Kidney complications Irritability Open wounds Sleep too much or too little Erectile dysfunction Best Contact Time Please select one9 a.m.-12 p.m.12 p.m.-3 p.m.3 p.m.-6 p.m. How soon would you like to have an appointment Please select oneThis WeekNext WeekThis MonthNext Month Message for Medical Staff Submit
