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Are you a referring provider? 

Please be sure to provide contact name, phone and email address for parents/guardians. Email address is important, as we send paperwork that needs to be filled out prior to the first office visit, as well as appointment confirmations. 

Are you a parent/guardian? 

Please be sure to include complete member ID and group numbers for your insurance.

If you intend to pay out of pocket, please enter "OOP" in each insurance field. 

We will need a valid email address to send required paperwork and appointment scheduling information.