Please print and fill out each form and bring to your first appointment.

General Information

Fee Agreement

Privacy Notification

Get In Touch

Contact me to see if I may be a good fit.

    If this is a medical emergency, please call 911.

    We highly respect and safeguard your privacy and will never disclose your email address and message to anyone. You acknowledge that the contents of this form will be sent via email and will be stored on servers located in the United States, and understand that you should not use it to provide any personal health information.


    My Office

    11098 Biscayne Blvd
    Suite # 401-27
    North Miami Beach, FL 33161