Appointment Request

Please complete the form below to schedule an appointment.
We will try our best to accommodate your request and will be in touch ASAP.

Together We Can Tackle What's Holding You Back

Appointment Request
Preferred Time

Agreement
By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form," you agree to hold Addiction Medical Solutions harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.
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