Please fill in the following information. Then click on the “Submit” button in order to initiate contact with Dr. Veurink. Once you have submitted your request for contact Dr. Veurink or his secretary will call you to set up a time for your initial appointment. Please allow up to two days for this.
Your private information will be kept confidential and never shared with other parties without your written consent. The one exception to this rule is if Dr. Veurink believes there is a danger to your life or others.
By submitting your request for contact to Dr. Veurink, you are giving him or his secretary permission to call the phone numbers you provide. You are also giving him or his secretary permission to identify Dr. Veurink by name and title and to leave a message on voice mail or with any live respondent who may answer the phone. This permission will remain active as long as your treatment will continue or until it is revoked in writing.
