Done through phone
+1 (833) 921-2783
Please complete all required fields to continue.
A $325.00 deposit is required to confirm your appointment and is refundable only if canceled at least 24 hours in advance. Late cancellations are non-refundable.
Clinic:
Address:
Date / Time:
Service: Medical Documentation
Provider:
Total service price: $325.00
Deposit required: $325.00
Balance to be paid in clinic: $0.00
