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

NEW PATIENT DEPOSIT POLICY

A $35 deposit is Required to secure your New Patient Appointment.

This Deposit is a Placeholder for your first Visit. It may be paid over the phone by debit or credit card, or in person using debit, credit, or cash.

By paying a deposit, you agree that your appointment with the doctor is important and you agree to the following:

Your Deposit will be applied to your first day charges (Copay or coinsurance for insurance patients.)

If a change is made to your New Patient Appointment:

  1. With more than 24 hours notice, The deposit is refunded or forwarded to the new appointment time.
  2. With less than 24 hours notice, the deposit is forfeited.
  3. If you miss your appointment (no show/no call) you forfeit your deposit.

**NEW PATIENT Appointments will only be scheduled up to  7 days in advance.**