Free Consultation Questionnaire

Please complete this form at least 24 hours before your appointment so our providers can prepare ahead. This will help you get the most out of your free consultation.

We ask that new patients read our financial policy and FAQ's before their first appointments. Don't have time? Here's what we want to make sure you know  before becoming a patient:

  • A $300 deposit is due at the time of scheduling a New Patient Appointment. The deposit goes toward the total cost of the appointment. Each provider has different pricing. You can view appointment pricing here. There is no deposit needed to schedule a Free Consultation.

  • Refunded deposits require a $25 processing fee (no fee for rescheduled New Patient Appointments with 2 business days' notice).

  • PIM is out-of-network and cannot accept insurance. Patients with insurance can submit for reimbursement after each visit. Medicare or Medicaid (even if it is secondary) cannot submit for reimbursement.

  • The cancellation policy is 2 business days . A late cancellation fee applies for appointments cancelled with less than 2 days' notice. Exception: For Free 20 Minute Consultations that are cancelled or rescheduled with late notice, there is no fee, but the consultation can only be rescheduled one time under this circumstance.

  • We see patients ages 11 years-old and up.

  • PIM is a good fit for patients who are engaged in their care. If you are scheduling for a family member, the prospective patient should be internally motivated. He or she must also be willing and able to communicate via the electronic patient communication portal. Pediatric patients, those unable to use computers due to physical disability and other patients (by special exception) can substitute a single person to communicate via portal on their behalf. Patients must also be able to sit in our waiting areas without disrupting others.

  • Patients 18 and older must schedule their own appointments (a legal guardian may schedule only if the patient is unable to).

Have questions? Contact us at or call 888.702.7974 x0.

Please be sure to read the policies listed above. We want to make sure you're in the know! *
Name *
As listed on health care coverage card

Please let us know if you no longer wish to keep your appointment so we can offer it to someone else in need of care. Our providers set aside time in their schedule for each consultation. If you need to cancel a paid appointment, please see our financial policy.

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