Email = firstname.lastname@example.org
Fax = 515-255-2228
Please download, print and sign this telehealth consent if you wish to use telehealth during the Coronavirus emergency. You can email it to email@example.com or fax 515-255-2228.
Please print and complete the appropriate intake packet and return with a copy of your insurance card to firstname.lastname@example.org or fax 515-255-2228. Once the packet and card are received, we will call you to schedule an appointment.