Clinic Appointment Request Form
If you would like to schedule an appointment in our clinic, please fill out the following form. Please note that this is a request and you will be contacted to confirm the appointment. Once the appointment is confirmed, all appointments must be canceled 24hrs prior to the scheduled check-in time. Late cancellations will result in a $15.00 fee that must be paid prior to rescheduling or receiving future services. Failure to cancel and then not arrive for your appointment will result in a NO-SHOW Fee, which will require that a $25.00 fee is paid prior to rescheduling, or receiving future services.