Patient Focused, Quality Driven
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Patient-Focused, Quality-Driven


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Telehealth visit for existing patients who have scheduled a time with their provider
2601 Mission St.
San Francisco, CA 94110
info@mysite.com
Tel 123-456-7890
Toll Free 1800 000 0000
Fax 123-456-7890
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Note: This form is for non medical questions, and should not contain Personal Health Information because it is NOT HIPAA COMPIANT. If you wish to communicate a medical issue or question, go to the PORTAL page or phone the office. NO REFILL OR OTHER MEDICAL INFORMATION SHOULD BE COMMUNICATED VIA THIS MESSAGE BOARD.
PHONE 248-655-1400
FAX 248-655-2646
ADDRESS
555 West 14 Mile, Suite 100
Clawson, MI 48017
(see Location on Map below)