Request A Consultation

Please answer a few quick questions so we can determine if we’re the right fit for your condition.

How long have you been dealing with this issue?

Which best describes your situation?

I’ve tried other treatments but the problem keeps coming back

I get temporary relief but it doesn’t last

I’m just starting to look for treatment

This clinic is a private, cash-based practice and does NOT accept insurance. Are you okay with that? (We do not accept insurance. However, we can provide a superbill for you to submit to your insurance for possible out-of-network reimbursement.)

Yes

Initial care often involves 2 visits per week for a short period to get results. Would you be able to commit to that if recommended?

Yes

Maybe

How soon are you looking to start treatment?

ASAP

Within the next few weeks

Just exploring options

Are you ready to address this with a structured treatment plan if we determine you’re a good fit?

Yes

Maybe

First Name *

Last Name *

Phone *

Email *

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