New Patient Scheduling Form

Please fill our scheduling form and we will contact you within one business day with appointment options.  Patients ages 18 and over must schedule their own appointments unless they are unable in which case their legal guardian may schedule. We see patients ages 11 and up.

If you have questions before scheduling, please request more information here.

Please read our financial policy and FAQ's before scheduling.

ONLY FILL OUT THIS FORM ONE TIME.  After that, simply contact us on the portal or email info@philly-im.com to schedule.

Name *
Name
As listed on health care coverage card
Date of Birth *
Date of Birth
Mobile Phone *
Mobile Phone
The Free Consultation can be done by phone or in-office and is optional. The consultations are exclusively with Annmarie and will allow time to ask treatment questions and talk about your health goals with Annmarie to help decide if you are ready to become a patient and find the best provider for you. Because you are not a patient at this time, our providers do not review medical records, give medical advice, or start treatment at this time. A New Patient Appointment can be done in-office only. This is when you begin your personalized treatment plan. We require a $300 deposit at the time of scheduling a New Patient Appointment. Dr. Tetlow is not taking new patients or free consultations at this time.
See below for the link to our membership page.
A $300 deposit is due at the time of scheduling for New Patient Appointments. The total price of a New Patient Appointment is $650. *
Would you like to participate in any of the following PIM Programs?
Check all that apply.

If you schedule a Free 20 Minute Consultation, 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.

For details on membership, click here.