• Let’s see if a visit is right for you

    This takes about 2–3 minutes. Tell us how to reach you. Dr. Hall personally reviews every request. For a medical emergency, call 911.
  • Who is filling out this form?*
  • Will the person receiving care be in California at the time of each visit?*

  • We aren't able to provide care outside California

    We can provide care only when you are physically located in California at the time of the visit. This is a licensure limit, not a preference, and there is no exception we can make.
  • What health coverage do you have?*

  • About your coverage

    We participate with Original Medicare and accept assignment. Your visit is billed normally; your Part B deductible and 20% coinsurance apply.

    Testing and medication are billed separately by the companies providing them.

  • About your coverage

    We do not contract with Medicare Advantage plans, so your visit is self-pay, at fees set at or below what Original Medicare allows for the same service — currently up to $300 for a new-patient evaluation and up to $215 for a follow-up. You will receive a Good Faith Estimate beforehand, and a superbill is available on request to submit to your plan for possible out-of-network reimbursement.

    Testing and medication are billed separately, and Medicare Advantage HMO plans may require some services to be arranged through an in-network clinician.

  • About your coverage

    We do not contract with commercial insurance plans, so your visit is self-pay, at fees set at or below what Original Medicare allows for the same service — currently up to $300 for a new-patient evaluation and up to $215 for a follow-up. You will receive a Good Faith Estimate beforehand, and a superbill is available on request to submit to your plan for possible out-of-network reimbursement.

    Testing and medication are billed separately, and HMO plans may require some services to be arranged through an in-network clinician.

  • About costs

    Your visit is self-pay, at fees set at or below what Original Medicare allows for the same service — currently up to $300 for a new-patient evaluation and up to $215 for a follow-up. You will receive a Good Faith Estimate beforehand.

    Testing and medication are billed separately.

  • Not sure which type you have?

    That’s okay. You can still submit this request. We can clarify your coverage before scheduling.

  • About you

  • Format: (000) 000-0000.

  • About the person who would be seen

  • About you

    Enter your information so we know how to reach you.
  • Format: (000) 000-0000.

  •  

    What happens next

    Dr. Hall reviews every request personally, and we’ll contact you about next steps.

    Sending this form does not create a patient-physician relationship or guarantee that evaluation or treatment will be offered. This form is not monitored for urgent concerns. For a medical emergency, call 911.

     

    Your Privacy

    Notice of Privacy Practices (PDF) 

    Website Privacy Policy (PDF)
     

  • Should be Empty: