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By submitting this form, you agree to be contacted by Performance, Health & Medical. Telemedicine availability and services vary by state, provider licensure, individual eligibility, and applicable regulations. This form is not for medical emergencies.

Before You Schedule

This form is not for medical emergencies. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room. Submitting this form does not establish a provider-patient relationship. Telemedicine availability and services vary by state, provider licensure, individual eligibility, and applicable regulations.