TELEHEALTH
All fields are required
Type of Visit
Free Initial Consultation-$0.00
Chronic Disease Care 65.00 (labs not included)
Acute Sick Visit Age 17-25 $39.00
Acute Care Visit Age 26 and up- $65.00
Medication Assistance - $25.00 per application
Weight Loss- $299.00 Monthly
Weight loss WITH Primary Care Services-$195.00/monthly
LAB REVIEW CALL- $0.00
Video Visit
Office
TELEHEALTH
Reason for Visit
(max 100 characters) e.g. Initial Consultation
Patient name
Firstname Lastname
Date of birth
mm/dd/yyyy
Email
email@example.com
Home phone
(555) 555-5555
Cell phone
(555) 555-5555
Requested time
Select a time below under Available Times
You must select a date and time for your appointment.
Available Times
Previous Week
Next Week
Visit Length:
30 minutes
Submit Appointment Request
You will receive an email confirmation.
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Action Required: Confirm your appointment