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SCHEDULE A HIPPA COMPLIANT VIDEO CALL


APPOINTMENT NECESSARY

PLEASE CALL #678-315-8122

TO SCHEDULE

OR

COMPLETE THE FORM BELOW TO

REQUEST AN VC APPOINTMENT:

First Name:

Last Name:

Email Address

Phone:

State:

Comments:

All fields must be completed and if you have suicidal thoughts or an emergency - DO NOT USE THIS FORM -

Contact 911 Immediately.

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