Request an Appointment

As of 2019, we are in network providers with Medicare only. We are no longer in network with major medical insurance.

However, you can take advantage of our discounted rates, provided the payment is made on the day the treatment is rendered (a.k.a. time-of-service). Oftentimes, these rates are actually lower than your in network rates.

If you would like us to check your Medicare information before your scheduled appointment, please submit your information in the comments box or call with the information at least two business days ahead of your appointment.
Patients Name*

Name
Email*
Phone*
Date of Birth*

Date Format: MM slash DD slash YYYY
Date of Last Visit*

Date Format: MM slash DD slash YYYY
Are you having any flu-like symptoms?*
COVID pre-screening questions for the saftey of patients and staff
- Yes
- No
Have you traveled outside of the Greater Houston area in the past month?*
COVID pre-screening questions for the saftey of patients and staff
- Yes
- No
Have you been in contact with anyone that has COVID-19 or tested positive for COVID-19?*
COVID pre-screening questions for the saftey of patients and staff
- Yes
- No
If you answered yes to any of the COVID pre-screening questions, have you self-quarantined for 14 days?*
- Yes
- No
- N/A
Type of service you are requesting*
Reason for Visit*
Doctor or Provider you'd like to see*
Message/Comments*

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West University Wellness - Houston, TX