Request an Appointment

Which clinic will you be visiting?

Your Information

Full Name

Phone

Preferred contact method

Email Phone

Reason for Visit

Condition / What brings you in?

Insurance By providing your insurance information, we can help you maximize your benefits. Laser Health Solutions does not direct bill.

Your Availability

Select all times that work for you. The clinic will contact you to confirm.

Day	Morning	Afternoon	Clinic Hours
Monday	Morning	Afternoon	9:00am – 6:00pm
Tuesday	Morning	Afternoon	9:00am – 6:00pm
Wednesday	Morning	Afternoon	9:00am – 6:00pm
Thursday	Morning	Afternoon	8:30am – 5:30pm
Friday	Morning	Afternoon	8:30am – 6:00pm
Saturday	Morning	Afternoon	9:00am – 5:00pm
Sunday	Morning	Afternoon	9:00am – 5:00pm

Day	Morning	Afternoon	Clinic Hours
Monday	Morning	Afternoon	8:00am – 6:00pm
Tuesday	Morning	Afternoon	8:00am – 6:00pm
Wednesday	Morning	Afternoon	9:00am – 5:00pm
Thursday	Morning	Afternoon	8:00am – 6:00pm
Friday	Morning	Afternoon	8:00am – 6:00pm

How Did You Hear About Us?

Patient Doctor Radio Word of mouth Internet Newspaper / Print Other

Anything Else?

Additional notes or questions

We typically respond within one business day.