Medical Advocacy | Premier Care Navigation

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What's Next?

Please fill out this form to help us prepare for your complimentary 20-minute Discovery Call. Providing detailed information ensures we address your specific needs and optimize our time together.

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Client First Name

Client Last Name

For whom are you seeking advocacy services?

If other, provide full name and relation to client

Phone

Preferred method of contact (choose one)

Best time to contact

How did you hear about Premier Care Navigation?*

Have you ever worked with a patient advocate before?

Who will participate in the Discovery Call?

What prompted you to contact us today?

Please provide your availability for the Discovery Call

What are your top 3 concerns?

List the primary diagnosis/diagnoses

How many physicians/specialists are involved in the client's care?

What type of assistance are you hoping for? (Check all that apply)

Understanding a diagnosis or treatment plan

Coordinating care among multiple providers

Preparing for medical appointments

Medication review or concerns

Insurance or specialty pharmacy issues

Care planning

Transition of care

Family communication

General healthcare advoacy

Other

What has been the most frustrating part of navigating the healthcare system?

If we could solve one problem for you in the next 30 days, what would make the biggest difference?

Is there anything else you would like me to know before we speak?

Thank you for contacting us!

The complimentary Discovery Call is an opportunity to discuss your situation, determine whether Premier Care Navigation is the right fit for your needs, and to explain how our services may help. Recommendations and detailed care planning will be provided after your Initial Comprehensive Assessment is completed.

Your Initial Comprehensive Assessment is included with your first month of service.

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Independent Clinical Nurse Advocacy for Complex Healthcare Decisions

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ESSENTIAL ADVOCACY

PRIORITY ADVOCACY

PREMIER ADVOCACY

COMPLEX CARE ADVOCACY

CONTACT

(760) 644-1201

Lisa@PCNCares.com

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