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Pran yon Randevou

Adrès
11601 Biscayne Blvd, Ste 303
Miami, FL 33181
Orè
Detay kontak
Lendi - Vandredi: 8am - 8pm
Samdi: 9am - 7pm
Sou randevou sèlman
Tel: 954-278-0487
Faks: 786-551-1905
Imèl: info @ lindaelmalcsw.com 

Pou enfòmasyon sou orè premye randevou ou oswa si ou gen nenpòt kesyon oswa enkyetid tanpri imèl
info @ lindaelmalcsw.com

Our team is looking forward to learning more about you and discussing how we may be able to help you. 

 

In order to begin the process please respond to form below with the following information and we will contact you as soon as possible so that we may speak about the next steps. 

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NOTE: If the patient is a minor, the parent or guardian is required to complete the form on their behalf.

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Please upload a copy of the front and back of your State Identification Card in order for us to verify that the information you have provided is your information.

State ID Card Back
State ID Card Front

Please upload a copy of the front and back of your insurance card  in order for us to verify your eligibility and benefits and also expedite the process. 

Insurance Card Front
Insurance Card Back

CONFIDENTIALITY STATEMENT

All information provided will be kept confidential.The personal information collected is only used by Life Skills Management Services staff for the purposes defined at the time of the collection or a use that complies with these purposes. We do not share your information with any third parties.

 

As mentioned above, we use your personal information to appropriately process your requests and present you with the information you need to obtain an appointment.

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We will not, in any circumstances, share your personal information with other individuals or organizations without your permission, including public organizations, corporations or individuals, except when applicable by law.

Mèsi pou mande yon randevou, mwen pral retounen nan ou nan 24-72 èdtan lè l sèvi avèk enfòmasyon ou bay la!

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