New Patient Scheduling Form

Please fill our our scheduling form and we will contact you within one business day with appointment options.  This is the fastest way to schedule an appointment. 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.

Only fill out this form once. If you have already filled it out, please email info@philly-im.com to schedule your appointment or contact us on the patient portal.

We recommend reading our financial policy and FAQ's before scheduling.

Name *
Name
As listed on health care coverage card
Date of Birth *
Date of Birth
Address *
Address
Mobile Phone *
Mobile Phone
The Free Consultation can be done by phone or in-office and is optional. The consultation will allow time to ask treatment questions and talk about your health goals with our providers to help decide if you are ready to become a patient. 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.

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.