Please complete the form below to request an appointment. Our scheduling team will contact you within 1-2 business days to confirm your visit. If you have any questions, please call our office at 772-398-7814.
Email Address
Do you have health insurance? YesNo
We welcome cash-pay patients! Please call our office directly at 772-398-7814 to schedule.
📞 Call to Schedule
Select Your Insurance Company: —Please choose an option—HumanaBlue Cross / Florida BlueAetnaMeritainCignaUltimateStraight Medicare (not Advantage)UHC PPOOther
Plan Type: PPOHMO
Insurance Card (Front):
Insurance Card (Back):
Driver’s License:
Full Name:
Email:
Date of Birth:
Phone Number:
🛑 HMO Plan Notice: We do accept HMO plans, but a referral from your primary care provider is required before scheduling.
The referral must include:
Your diagnosis
Authorization for at least 6 visits
Zero-visit or missing-visit-count referrals will not be accepted
Have your provider fax the referral to: 772-398-7812
Once we receive your referral with the correct visit count, we will contact you to schedule.