Please complete the form below then sign and click “Submit.” Accompanying medical records will need to be faxed to the preferred location using the following numbers.
Tulsa Fax: (918) 252-7466 Tulsa – Aesthetic & Laser Center Fax: (918) 940-2970 Grove Fax: (918) 787-7940
McAlester Fax: (918) 302-3088 Muskogee Fax: (918) 687-6610