Panacea Health Haven
All fields are required
Type of Visit
Free Consultation - 15 minutes
New Patient Visit - Telehealth $199
New Patient Visit - In Office $199
Established Patient - Telehealth $150
Established Patient - In Office $150
Established Patient Acute Care Visit - Telehealth $75
Established Patient Acute Care Visit - In Office $75
Membership Visit - Telehealth: No Charge
Membership Visit - In Office: No Charge
IM/SQ Injection
New Botox/Dysport/Filler/Microneedling
Existing Botox/Dysport/FIller/Microneedling
Video Visit
Office
Panacea Health Haven
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:
60 minutes
Submit Appointment Request
You will receive an email confirmation.
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Action Required: Confirm your appointment