In order to offer you an appointment, we need all three forms below filled out. Please be prepared to upload a copy/photo of the front and back of your insurance card(s). We will also need a copy/photo of the responsible person’s driver’s license or identification card. After we receive the forms, we will contact you within 48 business hours via phone or email. Our email will come encrypted and you will be required to create a password. Please save the password for future communications. Protecting your personal information is very important to us and these forms as well as our email is HIPPA secure.