Schedule your telemedicine appointment.

"*" indicates required fields

Choose Your Appointment Day & Time*

Legal Name*

Enter your legal name just as it appears on your Oklahoma DL or state-issued ID.

First Middle Last

Your Email*

Mobile Phone*

For your confidential telemedicine appointment, a camera-enabled smartphone is helpful. However, you may use any pc or tablet with a front-facing camera and microphone. You agree to receive text message confirmation(s) related to this and future appointments.

This field is hidden when viewing the form

Telemedicine Appointment Type (HIDDEN DO NOT REMOVE)

Oklahoma State Issued Photo ID

Max. file size: 512 MB.

A valid US Passport will also be accepted for proof of identity. An out of state license is not accepted.

Physical Address*

Street Address Address Line 2 City State ZIP Code

PO Boxes are not accepted as a valid physical address. The OMMA no longer requires doctor's form to match the patient's ID.

Date of Birth* (min age: 18)

Telemedicine Doctor Consultation*

Price:

You will submit your payment in the next step through a secure Square checkout. Remember, if for any reason you do not receive a recommendation, we will refund 100% of your consultation fee.

Coupon Code

Total

Credit Card

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