From time to time we communicate with patients by Email and Text messages for appointment reminders and messages. You may opt out of these messages at any time.
➤ We will need to photocopy your insurance card(s)
Please upload a file
List all medications you are presently taking including all prescriptions, over-the counters, herbals and vitamin/mineral/dietary (nutritional) supplements with each medication’s name, dosage, frequency and administered route (oral, sublingual, subcutaneous injections, and/or topical):