Chronic Illness Concierge Care Step 1: Please answer the questions below if you are interested to be in this group of patients for Dr. Teh.Step 2: After you submit, we will send you an email from Healveda Care. Email Address *What is your full name? *1. Have you been diagnosed with a chronic illness? *Yes I have oneYes, I have mor than oneNo, I have not been diagnosed with either of them2. Are you taking any prescriptions for your current condition? *YesNo3. Please note, I am unable to help women who are pregnant or nursing but I can give you a referral that may be able to help. Please let me know if you are pregnant or nursing below: *No, I am not pregnant/nursingYes, I am pregnant/nursing4. Which Autoimmune Conditions have you had? *5. What are your current antibody numbers? *6. What’s your current biggest challenge with? Explain below: *7. How much have you spent on trying to fix your current situation? *8. On a scale of 1-10, how committed are you to showing up for your health? *Select123456789109. What can I help you solve asap that would validate our trust and working together? (I am all about making people smile, what will make you happy?) Please explain below: *10. What are your worst symptoms? List the top 5. *11. Are you able to pay for the program if you are qualified? *YesNoSubmit