Registered client? Sign in
Service:Regular followup add another, change
Provider: No preference change
Date/time:Fri, Nov 24 2017 at 11:30 AM (EST) change

Welcome!  We respectfully ask that you take responsibility for committing to this appointment, being mindful of the impact that last-minute (non-emergency) cancellations and no-shows have on our small, independent practice.  By confirming below you agree to pay a $25 fee if you fail to show up or cancel with less than a 24-hour notice.  Cancellations are accept by phone message, email, or online. Thank you for understanding! :)

The information you enter here is completely confidential and for our internal use only.


Please do not submit any Protected Health Information (PHI)

Registered user? Sign in
Secret code
First name*
Last name*
Email*
Phone*
How did you hear about us?*
Notes
Home Number*
Mobile Number*
* required field