Please note that this form is intended for the uninsured adult patient with established seizure disorder or suspected to have seizure disorder and is willing to pay for his or her seizure disorder neurological care by an affordable payment plan. All patient must have a primary care provider in order to be seen at the clinic regardless of insurance status
Disclaimer:
By providing my phone number to “New Orleans Physicians On-Call, Inc.”, I agree and acknowledge that “New Orleans Physicians On-Call, Inc.” may send text messages to my wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to Opt-out by replying “STOP”. For more information on how your data will be handled please see our privacy policy below:
Privacy Policy:
No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.