1. Once you have a confirmed appointment date, please download, complete and send us the following PDF forms by email or fax to: michelle@davidwexlermd.com    Fax: (844) 684-8343

 

• Patient Registration

• Patient Financial Agreement

• Credit Card Authorization

• Consent to Release/Disclose Information

• Consent to Non-Secure Communication

• Medicare Exclusion Contract (65 or older)
   

2. In addition, once you have a confirmed appointment date, please fill out the:

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• REQUIRED Online Pre-Treatment Form

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Please note: we do not take insurance. A superbill will be provided to submit to your insurance carrier.

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