New Patient Intake | Southeastern Executive Health

Intake Appointment Request

Please fill out the form below, we will send you a secure intake form to your email address. Once that form is filled out and submitted, we can schedule your intake appointment.

If you would like to speak with our office before starting the process, please call us at (267) 361-1001.

By submitting, you agree to receive text messages at the provided number from Southeastern Executive Health LLC Message frequency varies, and standard message and data rates may apply. You have the right to OPT-OUT receiving messages at any time. To OPT-OUT, reply "STOP" to any text message you receive from us.

Sharing of Personal Information:

We do not share, sell, or disclose your personal information or mobile opt-in data to third parties without your explicit consent, except where required by law. Your information is kept confidential and used solely for the purposes you have agreed to. Mobile information will not be shared with or sold to third parties or affiliates for marketing and/or promotional purposes.

Opting Out of Text Messages:

You have the right to opt out of receiving text messages from Southeastern Executive Health LLC at any time. To opt-out, you can reply "STOP" to any text message you receive from us.

Consent and Opt-In:

By providing your phone number and opting in to receive text messages, you consent to the collection and use of your personal information as described in this policy. We ensure that your consent is obtained explicitly and that you are informed about the types of messages you will receive.