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Home > Request Service

 SERVICE REQUEST 

Please fill out this short form to help determine if Careborne Sensible Medical can service your request. We will get back to you promptly, usually within 2 hours. Can't wait? Call us! We will go over your options.

TYPE OF SERVICE
LEVEL OF URGENCY
SERVICE REQUESTED
PERSON SUBMITTING REQUEST

 TERMS AND CONDITIONS 

NO EMERGENCY
in emergency, please contact your nearest emergency medical services (911) immediately

LIMITED SCOPE OF PRACTICE
We are not a primary or urgent care physician’s practice: our services are limited to treating adult patients with common and non-emergent conditions. Patients - with multiple and/or complex health problems should seek care at a traditional full-service medical practice.

NO MEDICAL ADVICE
This communication is solely to inform you of our currently available services and providers, does not constitute medical advice, does not create a duty of care or a doctor-patient relationship, and is not a guarantee of medical care.

ELECTRONIC COMMUNICATION
By submitting this request, you are agreeing to communicate with us electronically through unencrypted (unsecure) means (web, email, and text) thus waiving our obligations under HIPAA with respect to secure communication. If privacy is a concern, please do not continue and call instead.

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