Schedule a First Appointment

A member of the Hypermobility MD team will follow up with you about whether we can help. Until you communicate with them, you are not officially on the waitlist so please return our phone call. Also read our office policies and procedures & pricing and package options before continuing. One-on-one medical care is expensive! If you need a more cost-effective option, or if you cannot travel to CO or WI for your first appointment (or attend your virtual follow-up appointments from CO or WI), coaching may be a better choice for you.

Your Information

First name

Last name

Phone number

Address

How did you hear about us?

I was referred to Dr. Bluestein by: (optional)

About Your Health

What are the top three medical issues you would like to address?

What do you hope to achieve in working with Dr. Bluestein?

What have you tried in the past?

Is there anything else you would like to add? (optional)

Important Acknowledgments

I understand that Dr. Bluestein does not accept insurance and that I will be responsible for payment before services are rendered. I am aware that most chronic medical conditions require time for improvement, and I will likely have to work with Dr. Bluestein over a reasonable period of time to improve my quality of life.

Appointment Preferences

Which in-person location are you willing and able to travel to for your first appointment?

Your first appointment must be in person. If none of these locations work, coaching may be a better option.

Littleton, Colorado: 8091 Shaffer Parkway Arvada, Colorado: 8795 Ralston Road Green Bay, Wisconsin: 2304 Lineville Road

Which package do you feel is the best fit for you?

Not sure? Review our package options in the FAQ or our pricing and packages.

Diamond (Most Complex): appropriate for most people who suspect EDS, HSD, POTS, or MCAS Platinum (Moderately Complex): appropriate for people who are NOT complex Gold (Least Complex): only for a single, straightforward problem

I confirm I am 18 years of age or older. If you are under 18, a parent or guardian must submit this form on your behalf.

Privacy notice

Your information is used solely to evaluate your suitability for Dr. Bluestein's practice and to schedule your appointment. All information is kept confidential and is never shared with third parties. Submitting this form does not guarantee an appointment or establish a patient-provider relationship.

Interested in Scheduling a First Appointment?

Your Information

How did you hear about us?

About Your Health

Important Acknowledgments

Appointment Preferences

Application received