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11Questions
Appointment Form
  • 1
    • DC
    • FL
    • IN
    • MD
    • MA
    • VA
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  • 3
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  • 4
    • Aetna (Commercial and Federal)
    • Aetna Better Health of VA
    • Anthem/BCBS (Commercial and Federal)
    • Anthem Healthkeepers Plus
    • Anthem Hoosier Healthwise
    • Beacon Health Options
    • CareFirst BCBS (Commercial)
    • CareFirst Community Health Plan
    • Cigna
    • Coventry Healthcare
    • Magellan/Molina Healthcare (Commercial and EAP)
    • Magellan/Molina Complete Care of VA
    • Meritan Health
    • Optima (Commercial)
    • Optima Family Care
    • Tricare
    • United Healthcare
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  • 5
    A picture with your phone is fine
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  • 6
    An Estimate is okay
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  • 7
    If not, please click on "previous" and change the number
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  • 8
    • Yes
    • No
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  • 9
    Due to a high number of individuals failing to present for their first appointment, a $55.00 fee will be assessed should you no-show or fail to present within ten minutes of the appointment.  My signature below indicates that I am aware of this policy and agree to pay should I not present for my appointment (applicable laws notwithstanding).
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  • 10
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  • 11
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Appointment Request
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