Telehealth Form

Please complete the Telehealth Consent Form prior to your visit using our secure online system.

PLEASE NOTE: On some systems, you may receive a 404 error message after submitting an online form.  The form is still submitted and you will receive a copy at the email and/or phone number that you entered in the first step.  We are working to resolve the error message, but it does NOT affect the secure online form submission.