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Book Your Appointment
Book Your Appointment

Book an Appointment

By meeting with our staff members, you will be able to give us more specific instructions. Set an appointment using the form below and receive a free assessment from us.

Basic Information

Personal details and contact information

Service Selection

Choose services and schedule preferences 

Medical History

Health information and medical background 

Emergency Contacts

Emergency contact details and authorized individuals 

Insurance Information

Coverage details and payments information

Consent & Agreements

Required consents and policy agreements

Documents upload

Upload require documentation

Review & Submit

Review your information and submit application

Important Information

  • Save your progress: Your application will be automatically saved every few minutes
  • Estimated time: The complete enrollment process takes approximately 25-35 minutes
  • Required documents: Please have ID, insurance card, and physician contact information ready
  • Need help? Contact us at 704-272-1766 if you have questions
  • Appointment

Fill The Form

Note: On submission, applicants may be redirected to the full application which they should fill out completely.

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