Orange County Critical Care & Pulmonary

Virtual Visit

Closed

PDT

REASON FOR VIDEO VISIT

CHOOSE A DATE AND TIME:

HAVE YOU BEEN TO ORANGE COUNTY CRITICAL CARE & PULMONARY BEFORE?:

No

Yes

PATIENT INFO:

Patient first name

Patient last name

Year

Mobile number

Email address

HOME ADDRESS:

Street Address

Apt, Suite, etc (optional)

City

ZIP code

HOW DO YOU WANT TO PAY?

Insurance

Self-Pay

I have read, understand and agree to Solv Health’s Terms of Service, Financial Relationships, and Privacy Policy.

I give my consent for the use of telemedicine in my medical care and have read, understand, and agree to these Terms

Bookings by Solv.

For emergencies please call 911