Request An Appointment
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Request A Video > please use this form
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Name (First and Last)
Date of Birth
Are you currently a Wellness For Life patient?
No, I would be a new patient
Yes, Last visit within 6 months
Yes, Last visit over 6 months ago
In office or long distance consultation?
In-office care is very hands-on and specific based on regular visits, while long-distance consultations via phone or Skype are more general.
In Office, I want a more detailed and specific care plan
Long Distance, I am unable to come to the office and want a general consult
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