New Patient Center

Please complete the form to request an appointment. Please note you do not have an appointment until you receive confirmation from us.

At this time, we are asking all New Clients to place a non-refundable “New Patient Pre-Payment” of $75 to hold your appointment spot. The Pre-Payment will apply to your charges on the day of your appointment. The Pre-Payment will be forfeited if you are a “No-Show” for that appointment.

* Name:

Patient Type:

New PatientCurrent PatientReturning Patient

Phone:

* Email:

* Preferred Date:

* Preferred Time Of Day:

MorningAfternoonEvening

Comments: