12200 Park central drive suite 110 Dallas Texas 75251
(833)352-4555
contact@thewellnesslounge.us
OUR APPROACH
OUR SERVICES
OUR TEAMS
CONTACT INFO
PATIENT FORM
OUR APPROACH
OUR SERVICES
OUR TEAMS
CONTACT INFO
PATIENT FORM
INFORMATIONS
Read our Policies and HIPPA Notices
➔ THE_WELLNESS_LOUNGE_FULL_CONSENTS PDF
REQUEST INFORMATIONS
Please read and complete the form(s)
➔ General Consent for Care and Treatment Consent Form
➔ Patient Consent for Financial Communications Form
Or download the required PDF form(s), print and complete.
Email the signed form(s) back to us using the link below.
➔ THE_WELLNESS_LOUNGE_GENERAL CONSENT_FORM PDF
FIRST NAME
LAST NAME
E-MAIL
I authorize the wellness lounge to use these informations to contact me by phone or email.
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