Complete the emailed Patient Intake Form

Complete the emailed Patient Intake Form

We have checked your information. It doesn't look like you have completed the "Patient Intake Form".  This is the form that the doctor uses to assess your smoking cessation history.

It will be in your email   ( Sometimes it does go through to Junk Email )


Once this is filled out the doctors will assess your application within 24-48 hours 


Please let me know if you have any issues


Best regards,

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