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  • Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.

    Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!
  • Appointment Type: Physician Prompt

    - We take extra effort to accommodate your appointment as quickly as possible, generally within 1-2 weeks.
    - Initial Visit + 3 month support ($1395)
    - $100 discount applies when forms are received prior to visit
    - $200 non-refundable deposit is required to book the Prompt Appointment.

  • Appointment Type: Physician Standard

    - Implies that we provide an appointment based on availability.
    - Initial Visit + 3 month support ($1175).
    - $100 discount applies when forms are received prior to visit.
    - $200 non-refundable deposit is required to book the Standard Appointment.

  • Appointment Type: Telemedicine (Video or Phone) Consultation

    - We provide an appointment based on availability.
    - Initial Visit ($1475).
    - $100 discount applies when forms are received prior to visit.
    - A $200 non-refundable deposit is required to book the Standard Appointment.

  • This field is for validation purposes and should be left unchanged.