Welcome! Please fill out the following medical history form so that we can move towards setting your appointment with one of our board-certified providers. We look forward to helping you with your episodic illness if we are able to! Please provide as much detail as possible.

These appointments are NOT for URGENT or LIFE-THREATENING care. These visits are for simple, episodic illnesses that are not urgent and can be treated easily via telemedicne. Please see our website for more information. If you feel that you are experiencing a SERIOUS, URGENT or LIFE-THREATENING ILLNESS please visit your closest Emergency Department or call 911.

I understand that I am electing to move forward with a concierge care appointment. These appointments are for minor urgent care issues and NOT for emergent or emergency care. For any urgent, emergent or life-threatening conditions I understand that I should seek care at an Emergency Department or call 911. Regardless of the reason for seeking care today, I understand that I should seek local primary, urgent or emergency care for any new, worsening or concerning symptoms. I understand that No Limits Medical does not provide opiates, SSRIs or Adderall for the treatment of any conditions. *

I AGREE

I DO NOT AGREE