Appointment Request Home » Appointment Request (561) 865-2550 Please complete the form below to schedule an appointment. We will try my best to accommodate your request and will be in touch ASAP. Appointment Request First Name * Last Name * Email Phone * Preferred Date * Preferred Time * Message Terms Of Use * Yes, I want to submit this form. By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form," you agree to hold Access Recovery Solutions, LLC harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means. reCAPTCHA If you are human, leave this field blank. SUBMIT Δ Subject to SEFBHN eligibility criteria.