TELEMEDICINE

Please complete the form below. Make a payment for

  1. $45.00 for a Medical Consultation for up to 15 mins
  2. $75.00 for Weight Loss consultation
  3. $100.00 for Suboxone Treatment Consultation

Note: Currently, we are accepting patients in PA state only for Telemedicine. We will be adding the other states soon.

Once our staff receives your completed form and the payment, you will receive a text for the time of your appointment.

Patient Registration

Let us know your personal and insurance details.

Select Male or Female
mm/dd/yyyy
xxx-xx-xxxx
if no insurance, write self insured.
If self, write self
if self or no insurance, write self.
If self pay, write None
If self pay, write None
if none, write none
select Yes or No
Select Yes or No
write your name
patient is 18 years or older write NA.
if patient is 18 years old or over write NA.

Select one below or enter the other value
Other Amount
Patient Name and D.O.B.(xx/xx/xxxx):

Thank you.

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