Waitlist

Thank you for your interest in working with Dr. Chong. At this time, she is only accepting a limited number of new patients. If you’d like to join the waitlist, please fill out the form below, and we’ll be in touch as soon as openings become available.

Name

First Name

Last Name

Phone

(###)

###

####

Date of Birth

YYYY

Preferred Communication

Are you interested in financial assistance?

Yes

Message

For privacy reasons, avoid disclosing health-related details