5454 La Sierra Drive, Suite 201 Dallas, TX 75231 - email@example.com
For Emergencies: Please call 911
Complete this form to be placed on our waiting list for a free Meet and Greet.
We are located on the east side of Central Expressway (US75), north of Walnut Hill Lane and south of Meadow Road.
LIve More Simply, Inc
5454 La Sierra Drive,
Dallas, TX 75231
We prefer e-mail: firstname.lastname@example.org
Telephone: (888) 923-2256, ext 1
ABOUT CONTACTING ME
Email / Phone
It Is Difficult For Me To Return Phone Calls
I do not have a receptionist, and I see patients without break and until late in the evening, so I get home too late to return phone calls, but not too late to respond by email.
The Best Way To Contact Me Is By Emailing me to
You can also leave me voicemessage at 888-923-2256 ext 1, but be sure to leave me your email address so I can return your message by email.
Name of insurance co or type "None"*
Patient Name (First, Middle, Last)*
Patient Birth Date*
I plan to pay with insurance or without *
I am interested in* (drop down)