FREE Assessment Form

FREE Assessment Form

Thank you for considering TMD & Sleep Solutions @ Life Amplified Solutions for your services.

The first step at our practice is a complimentary assessment. We take pride in evaluating you, before we proceed with your service. This allows you to ask any questions. In addition, at that time, we can confirm you are a candidate for the service. We will discuss with you risks and benefits, as well as, present to you alternatives if you are not a candidate. Please select the assessment or consultation you are interested in and set aside 1 hr of your time for that appointment.

*Please note, any appointments that no show or cancellations within 48 hours will be charged a $20 fee.*

Dr. Dorothy Kassab & Team

1810 Erie Blvd., Syracuse NY 13210

315-552-1050

315-697-9287

First Name*

Last Name*

Select or enter value

Phone #*

Email*

Appt Date*

Note: If this time conflicts with our schedule, we will call you to reschedule.

Appt Time*

Note: If this time conflicts with our schedule, we will call you to reschedule.

Select

Select a Service to Book*

Select

Additional Comments

Please leave any notes/comments regarding your appt/concerns.

Send me a copy of my responses

Privacy Notice|Report Abuse