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SELF-PAY OPTION
About this service
Before you continue
This service is offered on a self-pay basis and is not billed to insurance.
Step 2 of 4
Request a date and time
These are requestable clinic times. Your appointment is not confirmed until our staff reviews the current clinic schedule.
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Your information
SELF-PAY OPTION
About this service
Before you continue
This service is offered on a self-pay basis.
Insurance Information
Medicare
No-Fault Claim Information
Pricing Information
For your convenience, we accept cash, credit cards, and Apple Pay. Personal checks are not accepted.
Your self-pay rate and payment terms will be confirmed before you submit your appointment request.
Workers' Compensation Information
Patient Information
Payment Type
Step 4 of 4
Review your request
Please make sure everything looks right before sending it to the clinic.
This is an appointment request, not a confirmed appointment. Our staff will review the clinic schedule and contact you with confirmation or an alternate time.
Request received
Thank you. We have sent your appointment request to the clinic for review.
Your appointment is not confirmed yet. We will contact you after the schedule has been reviewed.