Open the secure form
Tap the button above to open Samantha's Practice Better questionnaire.
Your journey begins here
Private Health Intake
Complete your confidential health intake through Samantha's secure Practice Better form.
Your privacy matters
Complete your confidential health intake online
Your questionnaire is provided through Practice Better, where your answers are submitted directly to Samantha for review before your consultation.
Please answer as thoroughly as you can. If you prefer to speak with Samantha before completing the form, you are always welcome to call or email first.
What happens next
A simple, personal beginning
Complete your intake
Answer the health and lifestyle questions carefully, then submit the completed form.
Samantha reviews it
Your answers are available to Samantha inside her private Practice Better account.
Prefer to ask a question first?
You're welcome to reach out
No pressure and no obligation—just a friendly conversation about what you're looking for.