House Call Appointment

First Name

Last Name

Phone

Date of Birth (MM/DD/YYYY)

Have you used Houston Concierge Medicine before?

First Time Client
Return Client

Please be aware, we will make every effort to accommodate your requested time. Times are subject to change based on availability. A member of our team will work to confirm your appointment as soon as we receive your booking appointment.

What day are you requesting for your house call?

What time are you requesting for your house call?

HOUR

MINUTE

AM/PM

What is your house call regarding?

House Call

Please note: Additional $200 fee for weekends and after 5pm Mon-Fri. Additional fee for locations outside the 10 miles of the service area to be determined based on location.

House Call $500

Booster Shots

You may select multiple options:

Flu Shot + $149.00
Mental Clarity (NAD) + $149.00
Energy (B12) + $99.00
None

*Additional Fees*

Lab fees are an additional charge.
Additional $200 fee for weekends and after 5pm Mon-Fri.
Additional fee for locations outside the 10 miles of the service area to be determined based on location.

Cancellation of Services Policy

To best serve all of our patients, please review our cancellation policy:

⏰ 24-Hour Notice Required

We require at least 24 hours’ advance notice for all appointment cancellations.

If you cancel with less than 24 hours’ notice—or do not show up for your scheduled appointment—you will be charged the full amount of the service.

📅 Same-Day Bookings

If you book your appointment less than 24 hours in advance, please note that it cannot be canceled.

How did you hear about us?

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House Call Appointment

Thank you for contacting us!