New Patient Forms

Release of Information Form

***For New Patients for the First visit Only, we require a $150 Deposit. That is to reserve the appointment time, if you happen to miss the appointment or cancel less than 48 hours the Deposit is Non-Refundable***

Additional fees:
-A processing fee of $3.00 will be charged for credit/debit cards that cannot be processed.
     -Patient Assistance Enrollment is $25.00.
     -Prior Authorizations that require more than 1 correspondence are $25.00.