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Hallway Waiting Area

Get Started

Let's see if I can be of help to you. Please, fill out this short form. If you intend to use insurance, I will need your DOB. It will also help if you could text the front and back of your insurance card to 727-252-6060.

 

Most likely, I will call/email you back with some questions about your health situation. If we decide that it's worth trying acupuncture (and/or other therapeutic modalities), a registration link will be emailed to you.

Type of service
Service requsted
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TERMS & CONDITIONS

No Medical Advice

This communication is solely to inform you of our currently available services, does not constitute medical advice, does not create a duty of care or a doctor-patient relationship, and is not a guarantee of medical care.

 

Timing

The best way to reach me is by sending me an electronic message or email. At this point, I don’t employ any office staff: I personally respond to every communication. All non-urgent messages/requests will be processed within 2 business days. All forms, invoices, prescriptions etc. are sent out once a day, usually in the evening. If yours is an urgent matter requiring an immediate response, please text or call me at 727-252-6060.

Unencrypted Electronic Communication

By submitting this request, you are transmitting your personal information electronically through unencrypted (unsecure) means (web, email, and text). These types of electronic communication can be intercepted, read by or misdirected to a third party. You are agreeing to accept the possible risks associated with such unsecure communication thus waiving our obligations under HIPAA. You have the right to request that we communicate with you by alternative means. If privacy is a concern, please STOP HERE.

 

You agree to have this health care provider (we, us, our) as well as our business associates contact you via cellular telephone, standard text message (SMS), electronic mail (email), and/or any other form of electronic communication – including using pre-recorded messages, auto-dialers, and/or other forms of automated/electronic communication – regarding various aspects of your medical care, which may include, but shall not be limited to, test results, prescriptions, appointments, and billing. Standard messaging and/or data rates may apply. Unsubscribe at any time by replying STOP, clicking the unsubscribe link (where available), or replying to the email message with UNSUBSCRIBE in the subject line.

 

You confirm that you are the current owner/subscriber of the mobile number and email provided and agree that any communication sent to your email address and/or phone number will be effective once delivered, regardless of whether you choose to open/read it.

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