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BOOK AN APPOINTMENT at YOU’RE IN CONTROL!

CONGRATULATIONS! Today is the day you TAKE CONTROL!

Please provide the information requested on the form below to get the process started. We’ll get back to you with questions or an appointment date asap, usually within 3 business days.

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Important information regarding uploading image files on mobile devices:

If you are going to send us a photo of your identification, insurance cards, or doctor’s orders taken using your phone or tablet, please be aware that “live” photos or full/high resolution photos are too big to upload. Please use regular images, not “live” ones, and when uploading the images using the file upload buttons below, select a medium resolution (jpg or jpeg) file. You can also just bring your cards and doctor’s orders to your first appointment.

    Personal Information

     

    Preferred Contact Method(s):

    Date of Birth:

    Do you have a provider referral?*

    Referring or primary physician:

    Insurance Information

     

    Document Uploads


    Accepted file types are: 1) images in jpg, jepg, gif, and png formats, or 2) documents in doc, docx, and pdf formats. 2MB limit per document.

    Doctor's orders, if you have them:

    Drivers License or State ID:

    Front of primary insurance card:

    Back of primary insurance card:

    Front of secondary insurance card:

    Back of secondary insurance card:

     

    After you click the button below, you'll see a box appear underneath it letting you know if the information was sent successfully
    or if you need to correct any of your entries.

     

    Additonal information:
    • Fax number for physician’s orders and referrals: (844) 874-6349
    • Location information for our clinic, including address, directions, hours, and direct phone number, is here.