New Client Intake

Better Health Advisors is now Wellworth Health Advisors, underscoring our strong ties to family offices and individuals. As reflected in our mission to mitigate risk, we recognize and value the profound link between health and wealth-building strategies. We envision health management to be of equal importance as wealth management.

Please complete the information below. Better Health Advisors complies with all government privacy standards, and your health and demographic information is kept private and confidential.

Full Name:
DOB:
Address (where client lives & insurance bills):
Phone Number:
Email:
Primary Contact Name:
Primary Contact Phone Number:
Referred By:
Main Issue to Address:
Secondary Issues:
Urgent?
Insurance Card (front and back):
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Health Insurance Summary Plan Description:
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