Care 4 You Medical Waitlist

Please read

If you currently have a provider, we will be unable to accept your submission. This waitlist is for those without a practitioner or for those whose practitioner is retiring soon.

First and Last Name

Phone number

Email address

Number of people who would be completing intake (including yourself)

Do you currently have a practitioner/primary care provider?

Yes I currently have a primary care provider

If yes, we are not able to accept your submission

No I do not have a primary care provider Yes, but they are retiring

*Please specify below in notes when your provider is retiring, and their name*

Notes

Once your waitlist submission is complete, you will be contacted within approximately 8 weeks for a pre-screening and to receive information about the next steps. Staff is unable to confirm wait times so please refrain from calling the office for this purpose. Thank you.

Your information will be encrypted.