COMPLETE

1) DOWNLOAD FORM

2) Fill in all of the information, and sign it.      Review the Notice of Privacy Practices or Aviso Practicas de Privacidad

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3) Gather your 

1. Insurance Card(s)*

2. ID Card

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*Our full list of insurance plans we accept. Not insured? Not a problem. We can treat you as well.

REQUEST

Once you've completed the form and attached the documents on Step 1, email  or fax it to us at 305-412-9098 with:

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1. The preferred time and days of the week you'd like your treatments​

YOU'RE ALL SET

Once you've completed the form and emailed it to us with a copy of your insurance cards and ID you're all set! 

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We will then verify your insurance benefits including co-payments or co-insurance payments and the number of visits allowed. 

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One of our staff members will reach out to you within 48 hours, either via email or by phone to apprise you of your insurance benefits and set up your appointment.