By submitting this form, I consent to AvaOne Heart and Wellness contacting me by phone, text message, and email regarding my inquiry and appointment, and I understand that message and data rates may apply and that I can opt out of text or email communication at any time. I understand that the information I provide is used solely to schedule my appointment and respond to my inquiry, that AvaOne Heart and Wellness maintains the privacy of my health information in accordance with HIPAA, and that this form is not a secure channel for sharing detailed medical history, so I will not include sensitive health details here. For more information, please review our Privacy Policy and HIPAA Notice of Privacy Practices. This form is for scheduling purposes only and is not monitored for medical emergencies. If you are experiencing a medical emergency, please call 911.