new patient form

fill out the form below and OUR NEW PATIENT COORDINATOR WILL CONTACT YOU TO SCHEDULE an APPOINTMENT

We require a $75 nonrefundable deposit to hold your appointment. We have a $75 no show fee as well as a 7 day reschedule or cancellation policy. If you need to cancel or reschedule your appointment and do not give us at least 7 days’ notice, you will be charged a $75 fee. If you do not show up for your appointment, you will be charged a $75 fee.
Due to state licensing requirements, our healthcare providers are only permitted to offer services to patients who are physically located in Pennsylvania, Ohio, West Virginia, or Florida at the time of their visit. If you are not located in one of these states, you must be willing to travel to one of the aforementioned states for your appointment. We appreciate your understanding and cooperation.

We require a $75 nonrefundable deposit to hold your appointment. We have a $75 no show fee as well as a 7 day reschedule or cancellation policy. If you need to cancel or reschedule your appointment and do not give us at least 7 days’ notice, you will be charged a $75 fee. If you do not show up for your appointment, you will be charged a $75 fee.
Due to state licensing requirements, our healthcare providers are only permitted to offer services to patients who are physically located in Pennsylvania, Ohio, West Virginia, or Florida at the time of their visit. If you are not located in one of these states, you must be willing to travel to one of the aforementioned states for your appointment. We appreciate your understanding and cooperation.

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