Embedded Files
To Secure an Appointment, Please Complete the Intake Form. We will Promptly Respond via Email During Business Hours. Thank you.
Items You will need to Up-Load
- Health Insurance Card (front & back)
- Driver's License or Government ID (front)
- Please take a picture (image) of each of the items with your smartphone or tablet
- With-in the form you will find instructions on how to up-load the images
- The documents are necessary part of the intake and needed to complete the appointment process.
If you experience and difficulties with the on-line document please email the office.
- Please use Chrome web browsers only.
- Simply click the White button below to open the form.
Page updated
Google Sites
Report abuse