Registered client? Sign in

Service:	Smoking/appetite control - ear only add another, change
Provider:	No preference change
Date/time:	Sat, Nov 23 at 12:45 PM (EST) change

Welcome! We respectfully ask that you take responsibility for committing to this appointment, being mindful of the impact that last-minute cancellations and no-shows have on our small, independent practice. By confirming below you agree to pay for the full cost of your appointment if you fail to show up or reschedule/cancel with less than 24-hours notice (by phone message, email or online cancellation), or by Saturday if your appointment is on a Monday.

The information you enter here is completely confidential and for our internal use only.

Please do not submit any Protected Health Information (PHI)

Registered user? Sign in
First name*
Last name*
Email*
Phone*
Street address
City, state, zip
(New patients) Tell us a little about why you're coming in
Special instructions/requirements
Do you have an injury/disability and would like us to reserve a parking space for you? (our parking is limited)
Would you like to be notified if there's a sooner availability?
Days/times that might work best for you:
How did you hear about us?
I agree to pay for my appointment if I fail to reschedule at least 24 hours in advance, except in the case of a serious weather, illness or other emergency.*
Redemption code Enter code to redeem a gift certificate

* required field