Sara Gottfried MD

CLIENT Application Form

Dr. G is on sabbatical to complete her sixth book, but anticipates returning to consultation and coaching in 2024. She offers three different levels of care.

Options for coaching:

One-on-one consultation at $5,000 per 60-90 minute session via telehealth. No prescriptions or labs, but you can send up to 20 pages of prior lab work
Ketamine-assisted treatment for intake, preparation, ketamine treatment, integration (approximately $3,000 per month with a 6-month commitment). Available only to California and Pennsylvania residents.
Executive Health is the most comprehensive level at $30,000 per year.

Name*
first_name
Name*
last_name
Email*
Phone*
Home Address*
Street Address Address Line 2 City State ZIP Code
What level are you interested in?*
What are your top 3 performance, health, or leadership issues that you want to address with Sara Gottfried MD?*
Have you had blood or other testing performed in the past 12 months?*
What is the name, address, and contact information for your primary care doctor?
Doctor's Name
First Last
Doctor's Email*
Doctors Phone*
Doctors Street Address*
Street Address Address Line 2 City State ZIP Code
How soon do you want to begin?*

Sara Gottfried MD

CLIENT Application Form

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