Patient Application to Work 1:1 with Dr. Buttler


Please fill out this brief application and my team will be in touch!

Can't wait to meet you!

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Question 1 of 10

Name (First, Last)

Question 2 of 10

Complete Address (Street, City, State, and Zip Code)

Question 3 of 10

Best Contact Phone

Question 4 of 10

Best Email Address

Question 5 of 10

Date of Birth

Question 6 of 10

How did you hear about Dr. Buttler?

Question 7 of 10

Please list what you are looking to address in your health with Dr. Buttler?  

Question 8 of 10

Dr.Buttler is in-network with the following insurance companies Providence, Blue Cross Blue Shield, Pacific Source, MODA and HMA.( Dr.Buttler is not in-network with United, Cigna, HealthNet, AETNA, or Kaiser, but you may have out of network benefits for these plans. Please check with your insurance company and if this is the case then we can provide you with information to submit to them. This is not a guarantee of coverage.)


If you have one of the in-network insurance companies above, please list which one and provide your ID number and group number in the box below.  We then take this information and verify your coverage prior to your visit and discuss it with you. This is not a guarantee of coverage. Please check your policy to understand your coverage as well. 


If you are not using insurance, we offer a time of service discount and payment will be due at the visit. We will call you with this information so you can be clear about your financial obligation. 


Please list any other financial questions you have in the box below. 

Question 9 of 10

Everything Dr.Buttler does is about moving you towards your vision of health. He has seen miracles happen when people have been left hopeless with no path to healing. What is your vision of what you want your health to look like? 



Question 10 of 10

For fun, if you could have dinner with 2 people (not family) alive or dead, who would they be?

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