Be sure to fill the Patient Intake forms out completely, initial and sign all required places.
Please note, we cannot accept incomplete forms.
You will be automatically redirected back to this page after submitting the Intake forms so you can move on to the next Step!
Text or Email your Name, Phone and Groupon Voucher Number to
(813) 774-3474 or [email protected]
We will send you further instructions on how to schedule your appointment!
Do you need to have your doctor send us your medical records and or x-rays? Fill out our online Request for Medical Records.
If you already have your proof of a qualifying condition, such as medical records, x-rays, prescription, then skip Step 2 and jump directly to Step 3!
After your forms are submitted, you are redirected to our online scheduler.
Let us know if you have any issues. We are happy to help!
Next up is your appointment….
Remember, you must provide proof of your qualifying condition at time of appointment.
See you soon!
Not sure if you qualify? Complete the application below…
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