Full Name *

Phone *

Email *

Eligibility acknowledgment *

I am 18 or older and will be located in Texas during this telehealth visit.

Visit terms acknowledgment *

I understand this is a $150 telehealth physician visit, billed after the visit, and that booking does not guarantee a prescription.

Appointment text consent

I agree to receive appointment-related text messages from MMWL PLLC at the mobile number provided, including scheduling, reminders, and follow-up. Message frequency varies. Message and data rates may apply. Reply HELP for help or STOP to opt out. Consent is not a condition of purchase. Privacy Policy: https://drzuleikhatyebjee.com/privacy

Nurse callback consent *

If I don't schedule an appointment, I agree that Jeff, a registered nurse with MMWL PLLC, may call me at the number provided the next business day between 5:00 and 6:00 PM Central.

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