Telemedicine Request

Please enter your details below to be contacted by a medical doctor to discuss your medical history and condition. This information is sent directly to the medical office. Someone will contact you to set up an appointment within 72 hours.

We will do our best to call you during the time you prefer. Please note that due to a high volume of requests, we cannot guarantee the selected time.
This form is not a binding agreement and a physician will contact you to discuss fees and payment options. This service is not covered by insurance and you will be responsible for full payment for services rendered.


Medical exemptions are allowed in Pennsylvania for both masks and vaccinations. 

Vaccine exemption (K-12)

Vaccine exemption (Child Care)

Mask exemption