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Step 1 of 16

Please Note: Our in-person membership is now over 90% full

Patient Name❋

First Last

Please make sure the application contains the name of the patient and not another family member

Phone❋

>>>IMPORTANT<<

You MUST use a UNIQUE email address for the individual person applying for membership. Gmail offers a free account with parental monitoring for any child.
If an email is used that is already attached to an existing patient, their administrative record will be overwritten.

For non-minors, you may also follow these instructions to set up forwarding to another email address: Gmail forwarding❋

*Patient* Email Confirm *Patient* Email

For non-minors, you may also follow these instructions to set up forwarding to another email address: Gmail forwarding

Before you proceed, you may wish to review our Financial Policy in greater detail.

Please answer ALL of the following questions to the best of your ability:

I understand that RIFM is a functional medicine practice and not a 'concierge' medical practice* (if your application is approved, you'll received a detailed membership contract to review)❋

Yes

*More details can be found at: Does RIFM offer concierge medicine?

I've read the FAQ to address my questions about RIFM❋

Yes

I don't have questions

The FAQ page includes costs, what's covered in the membership, and numerous other questions

I will commit to meeting with my health coach during the sessions provided with my membership❋

Yes

Do you have a standard insurance plan?❋

Yes (e.g., Medicare, etc)

No, I wish pay cash (and I do not have other insurance)

No, I have a health sharing plan (e.g., Samaritan Ministries, MediShare, etc)

What is your main health complaint?❋

How often does it bother you?❋

Everyday

Once per week

2 to 3 times per week

Once per month

How long has it been going on?❋

1-6 months

1-3 years

Over 3 years

What (or who) would prevent you from completing a functional medicine program or plan (e.g., lifestyle changes, supplement supports)?❋

Children

Spouse/Partner

Money

Self

Job

Fear

Time

None of these

What have you tried so far that has or has not worked?❋

What is your current diet like? Please be specific: list breakfast, lunch, dinner and snacks, as well as the times you eat.❋

Are you taking any supplements or medications? Please list what you take and what it's for.❋

Note: It may help to leave spaces in certain medication names so they are able to be submitted (e.g., Va lium)

What would you like your health to be in 3 months from now? How about 6 months from now?❋

What obstacles, challenges, and struggles do you face regarding diet/lifestyle?❋

If we were to work together what would you expect to achieve from working with us?❋

What are 5 things you LOVE about your life?❋

Name

This field is for validation purposes and should be left unchanged.

Our Team

Aaron Hartman, MD is board certified in Functional Medicine, Integrative & Holistic Medicine, Family Medicine, as well as Anti-Aging & Regenerative Medicine. Dr. Hartman started Virginia Research Center in 2010 and RIFM in 2016. He is a Key Opinion Leader for Novum Nordisk in diabetes research; an assistant clinical professor of Family Medicine at VCU and a physician with RIFM.

Christian Jenski, MD joined Richmond Integrative & Functional Medicine in October of 2018. He is board certified in Emergency Medicine and Integrative and Holistic Medicine.

Christian Jenski, MD joined Richmond Integrative & Functional Medicine in October of 2018. He is dual board certified in Emergency Medicine and Integrative and Holistic Medicine.

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1 Park West Circle, Suite 301,
Midlothian, VA 23114

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Apply to Work With Us

Please Note: Our in-person membership is now over 90% full

>>>IMPORTANT<<

Before you proceed, you may wish to review our Financial Policy in greater detail.

Please answer ALL of the following questions to the best of your ability:

Our Team

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