Check off all that applies

TO BOOK A LIPEDEMA FUNCTIONAL CAPACITY EVALUATION, PLEASE FILL OUT THE FOLLOWING FORM. FIELDS WITH A RED STAR ARE MANDATORY. A MEMBER OF OUR SCHEDULING TEAM WILL CONTACT YOU DURING BUSINESS HOURS WITHIN 48 HOURS OF RECEIVING THIS FORM. IF YOU DO NOT HEAR FROM A MEMBER OF OUR TEAM, PLEASE CALL 818-722-2142 EXT 403

Call Now to Find out How   Ph: 818-722-2142
                                            Fax:  818-722-2143