Below are 5 information items. Print, fill out, sign and return to proceed with scheduling an initial appointment.
- 2026 Informed Consent
- 2023 Telehealth Informed Consent
- CMS – 1500 Image File (top only)
- Photo ID such as Driver’s License
- Photo of the front and back of Insurance Card(s)
The information below is for your reference and need not be returned