Patient Referral

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Terms of use

By agreeing to the terms of our secure forms, you will enter a secure area of our web site. Our practice will not be held responsible in the event your electronic message is not transmitted due to technical problems related to this site or to the hosting server. All personal identifying information is encrypted and your message will not be internally or externally forwarded to other third parties. The information will solely be used by our practice.

Your request will be processed within 24 hours, during normal business hours, Monday - Friday, 9:00 am - 5:00 pm, excluding holidays. If you do not accept the terms of this disclaimer, you will not be able to process your request on-line.

If you have any questions regarding the use of these forms, please contact our office during normal business hours.