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This form helps prospective clients and a physician connect more efficiently and explore whether the requested relationship will be a good fit, as physicians’ availability, skill set, and financial policies vary. This form ensures you find the right physician for your needs.

Disclaimer: Do not use this form to contact, if you are experiencing a medical or psychiatric emergency, including suicidal or homicidal thoughts, side effects to medication, or any other urgent and time-sensitive matter in which you need an immediate response.

Please call 911 or go to your closest emergency department.

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For any questions or queries please leave us a message and we will get back to you.

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this email and electronic messaging and wish to continue despite those risks.

Please call or text and you will receive a HIPPA compliant link to provide your information.