Schedule a telehealth visit with Amy Miller

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Step 1: Provide your contact information and request your appointment date & time
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Please confirm that you are in Florida and that you do not have Medicare, Medicaid, or Tricare* This field is required.
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We're so sorry, but this provider only sees patients in Florida, and does not see patients with Medicare, Medicaid, or Tricare at this time.

Please cick here to return to our website to find a nurse practitioner in your state.
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What is your legal first and last name?* This field is required.
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What is your date of birth?* This field is required.
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To order prescriptions, refills, labs, or referrals, we will need your Social Security Number. If you need any of these services, please provide this information.
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What is the best cell phone number to reach you at?* This field is required.
Please enter a valid phone number.
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What is the best email to reach you at?* This field is required.This is the email that we will send the telehealth link to.
example@example.com
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Please provide your address
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What is the reason for your appointment?* This field is required.Select all that apply!
I'm sick!
Preventive visit
New medications
Refill a prescription
I need labs ordered
I need a referral
Other
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What is the preferred pharmacy that you use?Please provide the address of the pharmacy in the event that you need a prescription or a refill.
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What date and time would you prefer see Amy? It may be helpful to provide a few different times that work with your scheduleAmy will review your request and respond in 24 hours.
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Ok
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Have you seen this provider in the past few years?
YESNO
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As you have not seen Amy in the past 3 years, please select the appointment type, "New Patient Telehealth Visit with Amy" on the next screen.
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Step 2: Make Payment* This field is required.You're half way done!
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ORDER SUMMARY
Total costUSD
Comprehensive Workup Telehealth Visit with AmyInitial weight loss management including lab orders and review. Hormone evaluation including lab orders and review
$119.00Edit
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Problem Focused Workup Telehealth Visit with AmyMore than one problem/sick; Sick and needing labs or referral; Refills with problem
$79.00Edit
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Annual Wellness Visit via Telehealth with AmyIncludes standard annual lab orders and review
$79.00Edit
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Uncomplicated Telehealth Visit with AmyEstablished Patients Only - Single problem/sick; Follow up weight management; Refills with no problems; Referrals only for insurance compliance
$49.00Edit
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Enter Coupon
Total cost $0.00
First Name
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Step 3: Complete Consent Forms

Last step! Please complete the following 4 notices. At the end of the notices, you will be asked to provide your signature.

In order for our nurse practitioner to treat you or make lab or prescription orders, we need to receive the next 4 consents from you.
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General Consent* This field is required.
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Telehealth Consent* This field is required.
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Financial Policy & Disclosure* This field is required.
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Patient Health Information Consent* This field is required.
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In the future, our practice will be taking insurance. Which insurance do you have, so that we can know once we get in network?
No insurance; I pay cash for my care
Medicare
Medicaid
BCBS or Anthem
United Healthcare
Humana
Cigna
Aetna
Other
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Take photo of your insurance card
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Please provide your signature* This field is required.Sign with your finger!
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Please provide today's date* This field is required.
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