Request a Consultation with a Medical Director/Therapist

Please note: Submission of this form is not confirmation of a scheduled clinical consultation.

The information you provide reflects the desired date/time that your office would like to have a clinical consultation performed. We will make every attempt to schedule a clinical consultation on the date of and within the 2-hour window you have selected. If we are successfully able to schedule a clinical consultation in accordance with your request, we will send an email confirmation with the exact time during which our Medical Director/Therapist Reviewer will contact you. This will reflect the start time of a 15-30 min appointment. If we are unable to schedule your clinical consultation within the 2-hour window requested, one of our agents will contact you telephonically to offer additional times.

Please be sure to include a direct contact number or add comments in the Message field to describe any phone tree nuances we may need to be aware of to ensure successful contact with your office.