Contact & ScheduleForms• Demographics • Health History • Policies & Agreement • Notice of Privacy PracticesIf you are unable to keep your appointment, kindly give 48 hours notice, otherwise you will be charged $50 for the time reserved. 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!NamePhone*Email* Preferred Date* Date Format: MM slash DD slash YYYY Preferred TimeMorningAfternoonEveningNature of Visit; Self Pay or Insurance CoverageCAPTCHACommentsThis field is for validation purposes and should be left unchanged.