Register An Appointment Now, Pay Later At The Clinic After Your Visit 
Registration NEVER costs you anything...Pay after your scheduled appointment!
Please enter the required information including how you heard about us, and the best phone number so our offices can reach you. Please include if AM, mid-day, PM, or anytime is the best time to contact you. Filling in all areas will only make it easier for us to have your complete information to start your appointment process quicker, but it is very important to fill in areas with the "red star" on the right side, these are necessary. If you were referred by a friend, patient, family member, or just plain word of mouth, please enter that persons name so we can give them proper credit from our current referral promotion. Make sure to fill in the security code at the bottom, this will allow an even more secure transmission. Your private information is only for the purpose of TrimCare charts, and contact. Your information will never be sold to any outside companies for any unsolicited emails, or spam. We respect your rights. Remember, online registration costs you nothing, you can pay after your scheduled appointment, we will call you soon!

How did you hear about us? (click drop-down button on right for choices)
First Name:
 *
Last Name:
 *
Reachable Phone #
 *
Email Address:
 *
Address:
City:
State:
Zip Code:
Best time to call & Name of referral (if referred)
 *
Security code:
 *
Do not enter anything in this field:
* indicates a required field

 

Legal Disclaimer: We feel this is a secure method of transmitting sensitive information across the Internet, we cannot warrant its suitability in all cases nor assume any liability for damages resulting, in whole or in part, from using this service to transmit your information. Note that under the Federal Privacy Rule (HIPAA) which went into effect 04/14/03 pressing the Submit/Send button signals your consent to transmit your private information. TrimCare Inc. does warrant that your information will not be disseminated except with respect to the TrimCare program.