Telehealth Appointment Form

Choose your preferred appointment type?

Appointment Type Selection

Please select the type of appointment you would like to schedule:

Weight Loss Program

For those without insurance or preferring out-of-pocket payment, you’ll acknowledge responsibility for full service costs upfront. We’ll confirm your preferred appointment date and time upon submission.

Payment Options

Will you be using insurance for your visit?

Note for Insurance Patients

Select insurance provider and enter policy details. Providing insurance information allows us to verify coverage and confirm your appointment time.

Self Pay

For those without insurance or preferring out-of-pocket payment, you’ll acknowledge responsibility for full service costs upfront. We’ll confirm your preferred appointment date and time upon submission.