Schedule Your Virtual Consultation

Fill out the virtual consultation request form below and we will reach out to you to schedule your virtual consultation.

We may require photos before your consultation. We will offer instructions on how to do this beforehand.

A consultation fee is due prior to your virtual consultation and can be applied to surgery costs or an in-person consultation. THESE FEES ARE DUE UPON BOOKING YOUR CONSULTATION AND ARE NON-REFUNDABLE FOR NO-SHOW APPOINTMENTS, CANCELLATIONS, OR RESCHEDULING THE DAY OF YOUR APPOINTMENT.

First Name *

Last Name *

Email *

Phone

Procedure Dropdown *

Decision Stage Dropdown

Message *

Email Singup

Yes! Please send me info on specials and events

HIPAA ACKNOWLEDGEMENT

Please be aware that this is a secure email network under HIPAA guidelines. Do not submit any personal or private information unless you are authorized and have voluntarily consented to do so. We are not liable for any HIPAA violations. Understand that if you email us, you are agreeing to the use of this secure method and understand that all replies will be sent by standard (unsecured) email, which you are hereby authorizing. By checking this box you hereby agree to hold The Langsdon Clinic, including its doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.

User Consent *

By checking this box, I acknowledge my understanding of the HIPAA Policy and agree with its contents. *

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