Please fill out the form below, then check your email to verify your request.

“We are a fee for service practice. Our practice does not accept any form of health insurance. We accept cash, credit cards and debit cards as payment methods. We do not accept checks.”

  • Date Format: MM slash DD slash YYYY
  • When submitting this form you will be taken to the next best step based on your responses above! We look forward to working with you 🙂