Episodic Care
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Episodic Care
Intake Form (For All Patients)
All patients, including those on the membership waitlist and those seeking episodic care, must complete an intake form. This form helps us gather essential information about your health needs.
Why choose Us
When to Complete the Intake Form:
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Book Your Medical Exam Appointment Today
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- Monday - Thursday
- 08.00 AM - 20.00 PM
- Friday - Saturday
- 08.00 AM - 16.00 PM
- Sunday
- Closed
Call Us
(+021) 123 662
Email Us
contact@domain.com
Schedule Your Check-Up
Intake Form
Please fill out the form to the best knowledge, that we may better assist you.
*For Client Reference (Form from Cortico Health Technologies goes here)*
Become a member Today!
Become a member today or fill out the episodic care intake form