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Please fill out your information in the form below, and our office will contact you to schedule and bill for your consult.


Doctor Consult Form

Doctor Consult Options

Contact/Billing Information

Payment Information

Please fill in the payment information below if this is your first consult and do not already have a credit card on file with the clinic. If we do not have this information and need it, we will contact you. Your credit card will not be processed until after connecting with a staff member to schedule your appointment.