Join the Waitlist for Dr. Spiritos

Join the Waitlist for Dr. Spiritos
Patient Name*

First NameMiddle ameLast NameSecond Last Name
Date of Birth*

MonthDayYear
Email*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
State
Location Verification

I understand that Ever Better Medicine provides telemedicine services in North Carolina and Illinois only and that I need to be physically located in North Carolina or Illinois for my appointment. I understand that services may be cancelled if I am outside of these states. I agree to truthfully disclose my location at each appointment.
Self - Pay Policy

All provider visit payments are out-of-pocket and due prior to the time of service. Please see our Pricing page for details. We do not bill insurance for provider visits; however, a superbill may be requested after payment and visit completion to submit for out of network reimbursement. We partner with a group called Sheer Health to support you through the reimbursement process.
Reason for Visit:*
Anything You'd Like Us to Know?
Date of Sign

MonthDayYear
Date
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