Name* First NameLast Name Email* ejemplo@ejemplo.com Phone number* What is your state of residence?* Select AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY How many children do you have and how old are they? What are the most frequent health concerns you have for your children that you would like to discuss during our consultations? By clicking "Send, I agree to the Terms of Service, Privacy Policy, Notice of Privacy Practices for HIPAA, Informed Consent for Telehealth, Refund Policy, and Mobile Texting Terms & Conditions. I hereby consent and state my preference to have a physician, nurse practitoner or nurse and other staff communicate with me by email or standard SMS messaging regarding various aspects of my medical care, which may include, but shall not be limited to, test results, prescriptions, appointments, and billing. I understand that email and standard SMS messaging are not confidential methods of communication and may be insecure. I further understand that, because of this, there is a risk that email and standard SMS messaging regarding my medical care might be intercepted and read by a third party. Send Should be Empty: Have us contact youAdd your information below and we'll contact you to book your initial appointment.
