Have questions with Patient Advocacy Consulting?

Have Questions?

Fill Out the Form for Patient Advocacy Consulting Inquiries

First Name *

Last Name *

Email *

Phone *

What is your primary motivation for seeking one-on-one coaching with Amy Rivera as a patient advocate?

Is there any additional information or specific questions you would like to share with Amy Rivera regarding the coaching program?

Are you willing to commit to the time, effort, and financial investment required for the duration of the coaching program?

Are you comfortable with sharing personal information and experiences related to your lymphedema journey?

How would you describe your preferred learning style? Do you thrive in a structured environment or do you prefer more flexibility?

How do you envision the role of a patient advocate in your lymphedema journey? What qualities or expertise are you seeking in a patient advocate?

What specific goals or outcomes do you hope to achieve through this coaching program?

Briefly describe your experience with lymphedema and any challenges or concerns you currently face in managing it?

Have you worked with a patient advocate or coach in the past? If yes, please share your experience and the impact it had on your journey

Are you open to exploring new strategies, techniques, and approaches in your lymphedema management?

How committed are you to making positive changes and taking proactive steps in managing your lymphedema?

What specific areas of lymphedema management do you feel you need the most support and guidance in?

Do you have video chat capabilities for the coaching sessions? (Google meet or Zoom)

Lymphedema Background:

How long have you been diagnosed with lymphedema? *

Which part(s) of your body are affected? *

What do you believe caused your lymphedema? (e.g., surgery, genetics) *

Current Management Practices:

What methods are you currently using to manage your lymphedema? (e.g., compression garments, manual lymphatic drainage, physical therapy) *

How satisfied are you with your current lymphedema management? (Scale of 1-10) *

Have you encountered any challenges with your current management techniques? *

Goals and Expectations:

What are your primary goals for seeking patient advocacy consulting? *

What specific areas of lymphedema management are you seeking advice on? (e.g., improving compliance with compression garment use, learning self-massage techniques, lifestyle modifications) *

Are there any specific outcomes you hope to achieve through our consulting services? *

Health and Lifestyle:

Please describe your daily routine and lifestyle. (Include any information relevant to physical activity, diet, and work environment) *

Do you have any other health conditions that impact your lymphedema management? *

How would you describe your current level of physical activity? *

Previous Treatments and Consultations:

Have you previously consulted with other lymphedema specialists or healthcare providers? If so, what was the outcome? *

Have you tried any lymphedema treatments or products that were particularly effective or ineffective? *

Support System:

Do you have a support system in place for your lymphedema management? (e.g., family, friends, support groups) *

How would you describe your current level of support and information regarding lymphedema? *

Additional Information:

Is there any other information you think is important for us to know about your lymphedema journey?

Do you have any specific questions or concerns you would like to address during the discovery call?

Availability for Discovery Call:

Please indicate your availability for a discovery call, including days of the week and times that work best for you. *

Consent for Contact:

I agree to be contacted by Rivera Hybrid Solutions regarding patient advocacy consulting services. (Check the Box) *

Agree

This comprehensive form will provide Amy and her team with a detailed understanding of the potential client's condition, management practices, goals, and challenges, enabling a more personalized and effective consulting approach.