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Thank-you, we have received your intake form, and you will be contacted by the next available Registered Nurse.

Action Required:

A Patient Medical History Form has been sent to your email address on file. Please complete the form and send it to us as soon as possible to proceed with your appointment request.

Troubles accessing the email? Use this PDF download to access our Medical Intake Form.
Medical Intake Form
Send your completed intake form to our secure email address
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