Yes - I do want to schedule a consult with FoundationMED/Dr. Citron or Dr. Sachar (please state if a specific physician preference). I understand that I will be contacted on how to register on the CHARM patient portal, and then be notified of appointment times as they become available. Please do NOT send any personal medical information on this form as it is not HIPAA secure. We encourage you to read the "New Patient Overview" for more information about FoundationMED
We are thrilled that you have chosen FoundationMED and look forward to seeing you!