• Request forms by email Email:   mannyg911@outlook.com

• Initial Evaluation (50 mins) - $ 440.  (Forms - Init Eval, Policy & Charges, CC auth)
  • INIT EVAL
    https://drive.google.com/file/d/1Kp3IXDfiFUyOm6Su0QKrHYzaQLWHPM_j/view?usp=sharing
    
    POLICY & CHARGES
    https://drive.google.com/file/d/1RJbxslyXcO5QkTlEn-YCk3kmf9iRUxmM/view?usp=sharing
    
    CC AUTH/UPDATE
    https://drive.google.com/file/d/13eNzJPdNsyabyQk1RTM6d07E01cKe44p/view?usp=sharing
    
    
• Medication Management (20 mins) - $220. (Forms - Follow-up visit, CC updates)  
  • MED UPDATE FORM     
    
    •  https://drive.google.com/file/d/16wiCXIKhqgRhjTSoU9VfJpfdqj77qTa3/view?usp=sharing                                               
  • CC AUTH/UPDATE    
    
    • ​https://drive.google.com/file/d/13eNzJPdNsyabyQk1RTM6d07E01cKe44p/view?usp=sharing
      
      
• Written or E-RX Med Refill Requests - $ 20.

​
Additional Services and Fees available per request. 

HSA, Credit /Debit Card, or Cash Payments Only! - due same day of service. Health Insurance Plans NOT ACCEPTED​.

Schedule Appointment