Make an New Patient [In Office] Appointment

If you would like to reserve an appointment, please fill out the following information:

* Indicates required questions
Name *
Email *
Address *
City *
State *
US/CA: or:
Zip/Postal Code *
Country *
Phone # *
Birthdate *
/ /
Occupation *
Referred to office by *
Major Health Complaint *
Medications currently taking *
Dietary Restrictions *
Any other major health problems past or present *
Would you like to see Dr. Tent D.C., Dr. Gill D.C., or Dr. Jeff D.C.? *

The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease. Thomas A. Edison