Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Check which options pertain to you *

Initial Consult with Dr. Mitchell (75 min. visit with Dr. Mitchell & 15 min. checkout) ($600) + 15 Lab Panel ($300)

Follow Up Appointments (50 min. visit with Dr. Mitchell & 10 min. checkout) ($375)

Out of state Patient (90 min. visit with Dr. Mitchell & 15 min. checkout) ($1,000) + 15 Lab Panel ($300)