REQUEST VISIT

To request a consultation, please take a few minutes to complete all required information below. Once submitted, you will receive an email confirmation notifying you that we are processing your request and will contact you within 48 hours to schedule your visit. Additional information will be provided to allow you to best prepare for your visit.

For a virtual visits only, submission of this form constitues acknowledgement that you may be responsible for a booking fee at the time of scheduling that will be applied towards your co-pay, deductible, or any remaining balance after submission to insurance.

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©2018 JEREMY A. BRAUER, M.D.