Book a Visit

Fill out the form below and a licensed provider will follow up with you shortly. Most visits are completed the same day.

24/7 Urgent Care AvailableOnline Consults, Anytime

Contact Information

Full Name *

Date of Birth *

Email Address *

Phone Number (optional)

Service Requested

Select a service *

Pre-filled from your service selection — change if needed.

Medical Information

Current Symptoms *

Current Medical Diagnoses

Height

Weight

Current Medications

Known Allergies

Past Surgeries or Procedures

Additional Notes

Preferred Pharmacy

If your provider prescribes medication, we'll send it to your preferred pharmacy. Please provide the full name and address so we can route your prescription accurately.

Pharmacy Name

Pharmacy Address

Payment

Erectile Dysfunction (ED)$60.00

Secure payment powered by PayPal. Complete your intake form and pay below.

Patient Consents

I have read and agree to the Consent to Treatment. *

I have read and agree to the Consent to Telemedicine Services. *

Secure checkout — complete your form above, then pay with PayPal below.

PayPal processes your payment securely. You'll be redirected to confirm your visit after payment.

By submitting this form you agree to our Privacy Policy. Your information is kept confidential and protected.

What to Expect

Quick Response

A provider will review your request and respond within a few hours during business hours.

No Insurance Needed

We accept self-pay patients. Flat-rate pricing — you'll know the cost before your visit.

Prescription Sent to You

When clinically appropriate, prescriptions are sent directly to your preferred pharmacy.

806 NW 16th Ave, Unit 390
Gainesville, FL 32601

(352) 451-6159 1-800-209-9215 (Toll-Free)

Fax: (352) 451-6159

[email protected]

Have questions first?

Browse our Services & Pricing page to see all conditions we treat and what each visit costs.

Your information is safe

All intake information is transmitted securely and kept strictly confidential in accordance with HIPAA guidelines.