Use this if the times online do not suit you, or if you have a question about whether we treat your problem
before you book. Our team reads these and calls you back.
Build notes, not patient copy.
The form posts to /api/request-a-call-PLACEHOLDER, a placeholder. The real endpoint is chosen after the
HIPAA memo and lands with a signed BAA. On success it redirects to /thank-you/, which is
what makes the submission measurable.
Fields built and held: Date of birth, Street address, Insurance carrier. Reason on each field in
src/data/booking-form.ts.