Below is a link to our Vaccine Only Consult demographics form and a link to our ID image upload portal. Please fill out form completely and make sure you received confirmation of submission. Please also upload a copy of a government issued ID for the patient (if the patient is a minor, upload a copy of the ID for the parent or guardian). ID is required for all services.
Regarding the security of these forms: Click here to find our more about how we secure the information you submit online. If you have any concerns about submitting your information online, please contact our office.