A consult is already in your cart! More than one topic may gladly be discussed during the same consult, so only one consult fee purchase is needed.

This form is for purchasing a consult.

Once you purchase a consult fee, our scheduler will contact you the same or next business day. Your contact information must be accurate in order to be contacted.

Once purchased, you may contact us:
Call or text (425) 428-4181
Email info@partingtonps.com

Patient Contact Information

First Name *

Last Name *

Date of Birth *

Phone *

Email *

Where are you located? (city/country) *

Billing Information

Use different billing contact information (optional)

Billing First Name

Billing Last Name

Billing Phone

Billing Email

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Street Address

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Pay with your credit card via Authorize.Net.

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Card code *

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I confirm that I have read and fully agree with these terms*

• This consult fee is applied towards the procedure but is otherwise non-refundable.

• My phone number and email are correct so I can be contacted.

• If I am in the USA or Canada, I will be called to schedule.

• If I am outside of the USA or Canada time zones, I may be emailed to schedule instead of a phone call.

• To schedule, I can call or text 425–428–4181 to reach the staff.

Order summary

Product	Subtotal
1 Consultation $200.00	$200.00
Subtotal	$200.00
Total	$200.00

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Order summary

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