Go Straight to Scheduling — No Office Visit Needed

If you have been referred for a procedure or qualify for direct access, complete the form below to skip the consultation and book your procedure directly.

This form is for patients who have a physician referral or who qualify to bypass an initial office visit. Once submitted, our team will contact you to confirm scheduling.

Start the Form Call Now

Skip the Consultation

Go directly to procedure scheduling

No Extra Co-Pay

Save time and reduce office visits

Fast Track Care

Streamlined booking for eligible patients

Direct Access Qualification

Complete this brief 3-step form to access the scheduler.

1Patient Info

2Procedure Info

3Confirm

Personal Information

First Name

Last Name

Date of Birth

Phone Number

Email Address

Procedure Details

Which procedure are you scheduling?

Do you have a physician referral?

Yes No

Referring Physician Name

Have you had this procedure before?

Yes No

Insurance Information

Insurance Provider

Insurance Member ID

Review Your Information

Please confirm your details

Patient Name—

Procedure—

Has Referral?—

Insurance—

Phone—

Email—

I consent to the collection and secure storage of my health information as outlined in the Privacy Policy. All data is protected under HIPAA. I certify that the information I have provided is accurate to the best of my knowledge.

Consultation Recommended

Based on your responses, we would like to schedule an initial consultation with Dr. Maher first. This helps us ensure you receive the safest and most appropriate care.

Schedule a Consultation Call (346) 637-4874

You Qualify for Direct Access

Our team will review your submission and contact you within one business day to confirm your procedure date.