By checking this box, I acknowledge:
We DO NOT ACCEPT HMO Insurance, State Insurance, Medicaid/Medicare, or discount plans.
I agree to the website's Terms and Conditions and have reviewed the Privacy Policy. The information I have provided is true and accurate to the best of my ability.
By completing this form, I agree to receive automated/pre-recorded phone calls, text messages, and reminders from the practice but I can opt out anytime."