Fill out health intake via phone/email to on our secure HIPAA compliant systems. Existing patients fill out the renewing intake forms provided.
2. Process Renewal
uConnect Medical Solutions
Confidential, Secure, Discrete.
Online shopping cart. We take security seriously and use layered PCI compliant merchant services. Click here to renew.
3. Physician Review
After doctor evaluates your health intake. Doctor can setup a phone call with you for your phone consult. You then will receive a digitally signed letter, a hard copy and email receipt.
Select your letter below
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Renewal Intake Provided Here
Secure Health Intake Form
Click thru the link to access the HIPAA secure intakeQ form. Simply enter your name and number to enter, fill out best you can, open/sign consent, and submit. That's it! Any questions give us an email, text, or call. firstname.lastname@example.org 800-840-4249
Not a problem, we have supplied the form link here. Since you are a returning/renewing patient our process can be either pay as you go and fill out form, or vice versa. We keep it simple. Click link below.