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The Signature Match: Application & Intake

You're in the right place.

This intake helps us understand your needs, history, preferences and goals so we can prepare for your 1:1 Signature Match session and curate aligned wellness providers — without the searching, guessing, or starting over.

Complete the form below and you’ll receive access to book your consultation.

Full Name

Email

Phone Number

City

How do you prefer sessions?

How do you prefer sessions?
A
B
C

When are you hoping to begin?

When are you hoping to begin?

When are you generally available?

When are you generally available?

Budgeting & Service Costs

To give you a sense of what’s typical in the Boston area outside of the providers that take insurance (these vary by experience, specialty and format):

Therapy or Coaching: $150–$300 per session

Functional Health/Nutrition: $350–$650; most providers offer programs/packages

Bodywork: $150–$250 per session

**Rates may be higher/lower depending on the provider

What feels aligned for ongoing care?

What feels aligned for ongoing care?
A
B
C
D

Do you plan to use insurance or HSA/FSA?

Note: some services/providers do not accept insurance
Do you plan to use insurance or HSA/FSA?
A
B
C
D

What are you seeking support for? (Select up to 3)

What are you seeking support for? (Select up to 3)

How urgent does this feel for you?

How urgent does this feel for you?

What types of providers are open to/looking for?

What types of providers are open to/looking for?

Provider vibe - what fits you best?

How do you tend to connect best with someone supporting you?
Provider vibe - what fits you best?
A
B
C
D
E
F

What types of support or specialties are you most interested in exploring? (Select all that apply)

What types of support or specialties are you most interested in exploring? (Select all that apply)

What would you like to avoid in a provider or their approach?

Have you worked with providers for this before?

Have you worked with providers for this before?
A
B
C

If yes, what worked and what didn't

Current diagnoses or considerations you want your provider to know?

Current medications or supplements?

What phase of life best describes where you're at?

What phase of life best describes where you're at?
A
B
C
D
E
F
G
H

In your own words: what feels off, what’s weighing on you and what would feel like relief?

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Terms & Policies

By submitting this intake and booking a Signature Match Session, you acknowledge that The List provides personalized referral and matchmaking services only. The List does not offer medical care, diagnosis, treatment, or clinical guidance, and participation does not create a patient–provider relationship with The List.

All matches and recommendations are based on the information you share and are intended for informational and referral purposes. You are solely responsible for evaluating any provider’s qualifications, licensure, scope of practice, availability, and fit before beginning care.

While every provider within our network is vetted with care, The List does not guarantee outcomes, results, or specific improvements, and is not liable for the actions, advice, or treatment you may receive from any referred practitioner.

Refund Policy Because each curation is created individually and work begins immediately upon booking, all payments are non-refundable once your Signature Match Session is scheduled. If you believe a payment was made in error, please reach out within 24 hours at [email protected] for review. Requests received after 24 hours cannot be accommodated.
Satisfaction Policy

Matches are curated based on the details you provide, but The List cannot guarantee a perfect fit with every provider. If you feel a recommendation isn’t aligned, you may reach out within 7 days to discuss options.