Name *

First Name

Last Name

Phone *

Which phone number would you like us to call you on for your FREE CONSULTATION?

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How did you find out about Confluence Wellness? *

My Healthcare Provider

Friend or Family Member

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Acknowledgement of the nature of Confluence Wellness Services *

While Amber Valenti Armstrong, PA-C, is a medical provider, in the context of our health education and coaching work together, no patient-provider relationship will be created. All Confluence Medicine consultation services are solely for educational purposes and to support you in creating your most vibrant health.

I understand and agree to the above statement.

Electronic Communication Notification *

There are inherent confidentiality risks with the use of any type of electronic transmission, including email, phone, text, video conferencing, and the submission of this online form. Amber Valenti Armstrong and Confluence Wellness strive to stay educated about the most recent forms of electronic communication security in regards to sharing information electronically and in compliance with professional standards. I acknowledge that complete confidentiality cannot be promised in regards to the FCC, Homeland Security, hackers, and common data loss that may happen with electronic transmission use. By submitting this form, I give Confluence Wellness and Amber Valenti Armstrong permission to contact me by phone and email.

I understand and agree to the above statement.