First Name Last Name New or Established Patient I am new to this clinic I am an established patient Type of Visit Telehealth Visit In-Person Clinic Visit First Available Your Email Address Your Phone Number Your Primary Care Physician Name Your Primary Care Physician Phone and Fax Numbers Your Insurance Name Reason For Consultation Failure to cancel at least 48 business hours prior to your appointment will incur a $45.00 cancellation fee. Please call our office to speak with one of our team members.