To schedule an initial consultation, please complete, filling in all the requested information, and then submit this form. Dr. Haley will get back to you by email as soon as she can. Please note that due to time constraints and frustration with tag-telephone, Dr. Haley can only respond to you by email so Please be sure that your email address is entered correctly.
If you do not plan to use health insurance to help pay your fees, skip this section. Otherwise, please answer the following:
** Please check to ensure that you have provided your correct email address in the space provided. Due to time constraints and frustration with tag-telephone, Dr. Haley can only respond to you by email. **
Okay, now, click the send button below and you will be contacted via email, usually by the weekend following receipt of this form, about scheduling a meeting with Dr. Haley.
Please be patient and wait until you arrive at the "thank you" page before leaving this page. Otherwise, your form will not be transmitted. Thanks.