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REQUEST AN EVALUATION
This form allows us to briefly understand your situation, reason for consultation, relevant background, and preferred mode of care.
Completing the form takes approximately 3 minutes. Submitting the form does not confirm an appointment; Semper Ludus will review the information before suggesting the next steps, date, and type of service.
IMPORTANT NOTICE
This form is not an emergency service. If you are experiencing chest pain, severe difficulty breathing, loss of consciousness, sudden weakness, significant bleeding, a recent serious injury, or any other symptom you consider urgent, do not complete this form to request care.
Go to the emergency room or contact your local emergency services.
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