PHONE: 954-776-7566
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PATIENT'S DATE OF BIRTH

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CONTACT PERSON'S NAME
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SERVICE
Please select one or multiple services from the following list. Prescription drugs require a valid prescription on file in our office before any order can be processed. For any questions please contact our office: (954) 776 7566

1. Initial Office Visit A $104.002. Initial Office Visit B $230.003. Initial Office Visit C $205.004. Follow Up Visit D $80.005. Follow Up Visit E $105.006. Follow Up Visit F $155.007. Laboratory Blood Test CBC w/ Diff/ Chemistry 25/ Sed Rate $130.008. Laboratory Blood Test CBC w/ Diff/ Chemistry 25 Only $110.009. Lab. Blood Test Testosterone Free/ Testosterone Total/ PSA $150.0010. Lab. Blood Test Testosterone Free/ Testosterone Total Only $100.0011. Laboratory Blood Test Hepatitis ABC $175.0012. Laboratory Blood Test Rheumatoid Arthritis Panel $70.0013. Laboratory Blood Test Thyroid Profile w/ TSH $70.0014. Urine Drug Screen $30.0015. Urine Drug Screen & Urine Analysis $30.0016. X-Ray $100.0017. EKG $50.0018. Injections B12 $10.0019. Injections Testosterone 1/2cc $20.0020. Injections Testosterone 3/4cc $25.0021. Injections Testosterone 1cc $30.0022. Injections Trigger Point $75.0023. Injections Cortisone $75.0024. No Show Fee $20.0025. One Week Office Visit $55.0026. Certified Mail Script $10.00

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