New Patients We are now accepting new patients. Please note that we do not accept any form of insurance. However, we do provide you with the necessary paperwork to file a claim with your provider. We will contact you by phone to schedule your first appointment. New Patient Appointment Request Patient's Full Name * First Name Last Name Your Name & Relationship to the Patient (if applicable) First Name Last Name Patient's Date of Birth * MM DD YYYY Phone Number * (###) ### #### Email * Who referred you to Dr. Cantu? Reason for Treatment * Please list all medications you are currently taking. * Any other notes you would like to include? Thank you!
