top of page

NEW PATIENT REQUEST

Please fill in the information below and click submit.

We will call you to schedule your appointment at Vadim Baram Inc!

New Patient Request Form

Thanks for submitting!

If you want to pay your copay or balance, we accept all credit cards or other means of payment. To simplify the process, you can use following applications: cash app, Zelle or Square. Just enter: pay to baramvy@yahoo.com

NEW PATIENTS

Forms will open in a new window. Select the download option, fill out the live fields, save, and email to:

10420oldolive@gmail.com

bottom of page