Bossa Nova Health

Your body is unique.

Your health should be too.

"Dr. Marina"

At Bossa Nova, we work with functional medicine, applied genetics, and longevity protocols designed for those who seek to live longer and better.

This form helps us understand your history, your goals, and the subtle signals your body may already be sending.

What's your full name?

Contact phone number

When is your birthday?

What are your main health concerns and symptoms?

Why are you seeking Functional & Regenerative Medicine?

Are you willing to commit to a structured 3-month protocol?

Are you willing to commit to a structured 3-month protocol?

Yes

Do you take any medications or supplements? If yes, which ones?

Have you been diagnosed with any of the following conditions?

Have you been diagnosed with any of the following conditions?

Metabolic & Endocrine Health: Hypothyroidism, Hashimoto’s, PCOS, insulin resistance,adrenal fatigue, menopause, testosterone deficiency, metabolic syndrome.

Neurological & Cognitive Health: ADHD, anxiety, depression, brain fog,neuroinflammation, migraines.

Autoimmune & Inflammatory Disorders: Rheumatoid arthritis, lupus, chronic fatigue,fibromyalgia, irritable bowel syndrome (IBS), Crohn’s, ulcerative colitis, chronic skin conditions(eczema, psoriasis).

Cardiovascular & Circulatory Health: Hypertension, high cholesterol, dyslipidemia,endothelial dysfunction.

Digestive & Detoxification Health: Fatty liver, gallbladder dysfunction, SIBO, chronicbloating, histamine intolerance, food sensitivities.

Other Conditions: Recurrent infections, allergies, chronic sinusitis, unexplained fatigue,hair loss, hormonal acne.

Do you have a family history of any of the following?

Do you have a family history of any of the following?

Neurodegenerative diseases (Alzheimer’s, Parkinson’s, multiple sclerosis)

Cardiovascular risks (heart disease, stroke, aneurysm)

Metabolic risks (type 2 diabetes, obesity, insulin resistance)

Hormonal imbalances (thyroid disorders, early menopause, infertility, endometriosis)

Cancer (breast, prostate, colon, lung, ovarian, pancreati)

Do you agree with the sending of this information?

Do you agree with the sending of this information?

Yes

Signature

Transparency with Care
About Your Consultation

Your first consultation with Dr. Marina is a meaningful step:

we explore your full health history, genetic background, habits, and goals.

It’s a deep, focused encounter.. with time, attention, and real insight.

The total cost of the consultation is AED 1,470.

To confirm your appointment, we ask for an upfront payment of AED 1,000, which:

• Is fully deducted from the total consultation fee.

• Can be used as credit if you choose to continue with a personalized health plan.

• And if you prefer not to move forward, you’ll simply pay the remaining AED 470 on the day of your visit.

More than a consultation, this is the beginning of a journey tailored to you.. grounded in science, care, and longevity.

Transparency with CareAbout Your Consultation

Yes, I understand and would like to proceed

I still have questions — please contact me.