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Appointment Form

Patient ‘Call Back’ Appointment Form

Call 1-800-392-2623 or (310) 820-6042 to schedule your appointment with Dr. Galitzer.
Please complete and bring the following:

• New Patient Questionnaire (PDF)
• Prior lab work from the past 2 years
• Any medications, vitamins or supplements you are currently taking

This provides Dr. Galitzer with vital information necessary to prepare your personalized Anti-Aging and Regeneration program.

Or fill in your details below and we will call you back:

Client Appointment Form
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