Request a Virtual Appointment

Request a Virtual Appointment
Discounted Virtual Consultation (10-15 minutes) – $85Extended Virtual Consultation (15-20 minutes) – $110
Discuss Side EffectsDiscuss a Medication ChangeOther Concerns (please add more information on the next page if selected)
Other Concerns:*

0/150
Cancellation Agreement: By checking "I agree" below, you acknowledge and accept our strict cancellation policy. If you need to cancel or reschedule your appointment, you must notify our office at least 2 full business days in advance (please note that weekends do not count as business days). Failure to provide sufficient notice will result in being charged the full price of the consultation, as time is specifically set aside for you with our Nurse Practitioner, which represents a significant cost to our practice.*

I Agree
TextEmail

Important Next Steps for Your Prescription

We are about done! Before you submit payment to finalize your prescription, please review the following:
Send to my email on recordSend to a new email
Enter your Email:*
example@example.com

My Products*

Discounted Virtual Consultation (10-15 minutes)

$85.00

Extended Virtual Consultation (15-20 minutes)

$110.00

Enter coupon

Total

$0.00

Important Notes:
- We look forward to talking to you on {ltstronggtappointmentltstronggt}.
- Remember that If you are experiencing severe symptoms or require urgent assistance, please call 911 or visit your nearest emergency room or urgent care center. We are not an emergency resource, even during business hours.
Should be Empty: