Is this a request for a new or a returning patient?

    • [[{"field_id":15844,"subrules":{"field_id":15842,"value":"New Patient","operator":"Match"}}],[{"field_id":15843,"subrules":{"field_id":15842,"value":"Returning Patient","operator":"Match"}}]]

Please choose the type of visit

    • [[{"field_id":15844,"subrules":{"field_id":15843,"value":"Orthopedics - Follow-Up Visit - In-Office","operator":"Match"}}],[{"field_id":15844,"subrules":{"field_id":15843,"value":"Video Telehealth - Returning Patient Visit","operator":"Match"}}]]

Is your PCP a MFM Health or AllaraCare Medical Group Provider?