You can always press Enter⏎ to continue

Ideal Option Appointments

HIPAA

Compliance

  • 1
    What would you like to do today?
    Press
    Enter
  • 2
    If you select YES, please be sure to click SUBMIT to access the rescheduling tool.
    Press
    Enter
  • 3
    Press
    Enter
  • 4
    Ideal Option does not offer methadone but we can help patients transition from methadone to buprenorphine.
    Press
    Enter
  • 5
    Healthcare workers are legally required to contact law enforcement if a patient operates a motor vehicle while impaired or under the influence of drugs or alcohol. Please ensure that you do not drive yourself to your appointment if you are impaired. Get a designated driver, cab, ride-share, or use public transportation if you might be impaired. Ideal Option recommends having a responsible adult friend or family member accompany you to your appointment.
    Press
    Enter
  • 6
    If your state is not listed, we apologize but we are not licensed to provide services to you at this time.
    Alaska
    • Alaska
    • Arkansas
    • Idaho
    • Maryland
    • Montana
    • New Mexico
    • North Dakota
    • Oregon
    • Eastern Washington
    • Western Washington
    Press
    Enter
  • 7
    Providing an address will help your pharmacy process your prescription with fewer delays. If you don't have a permanent address, please leave blank.
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
    Press
    Enter
  • 8
    We will schedule your appointment at the clinic closest to this zip code.
    Press
    Enter
  • 9
    We'll try our hardest to get you scheduled at the clinic you select.
    Alaska
    • Anchorage
    • Fairbanks
    • Kenai
    • Wasilla
    Press
    Enter
  • 10
    In the event your desired clinic is full, we can get you scheduled at any clinics you select below. Please select all that apply.
    Press
    Enter
  • 11
    We'll try our hardest to get you scheduled at the clinic you select.
    • Bentonville
    • Conway
    • Fayetteville
    • Fort Smith
    • Hot Springs
    • Jacksonville
    • Jonesboro
    • Little Rock
    • Paragould
    • Russellville
    • Van Buren
    Press
    Enter
  • 12
    In the event your desired clinic is full, we can get you scheduled at any clinics you select below. Please select all that apply.
    Press
    Enter
  • 13
    We'll try our hardest to get you scheduled at the clinic you select.
    • Kennewick
    • Pullman
    • Spokane 5th Ave
    • Spokane Francis
    • Spokane Valley
    • Walla Walla
    • Wenatchee
    • Yakima
    Press
    Enter
  • 14
    In the event your desired clinic is full, we can get you scheduled at any clinics you select below. Please select all that apply.
    Press
    Enter
  • 15
    We'll try our hardest to get you scheduled at the clinic you select.
    • Boise
    • Caldwell
    • Coeur d'Alene
    • Idaho Falls
    • Kellogg
    • Lewiston
    • Pocatello
    • Sandpoint
    Press
    Enter
  • 16
    In the event your desired clinic is full, we can get you scheduled at any clinics you select below. Please select all that apply.
    Press
    Enter
  • 17
    We'll try our hardest to get you scheduled at the clinic you select.
    • Catonsville
    • Cumberland
    • Frederick
    • Hagerstown
    • Waldorf
    Press
    Enter
  • 18
    In the event your desired clinic is full, we can get you scheduled at any clinics you select below. Please select all that apply.
    Press
    Enter
  • 19
    We'll try our hardest to get you scheduled at the clinic you select.
    • Billings
    • Bozeman
    • Butte
    • Cut Bank
    • Glasgow
    • Great Falls
    • Helena
    • Kalispell
    • Missoula
    Press
    Enter
  • 20
    In the event your desired clinic is full, we can get you scheduled at any clinics you select below. Please select all that apply.
    Press
    Enter
  • 21
    We'll try our hardest to get you scheduled at the clinic you select.
    • Bismarck
    • Fargo
    • Grand Forks
    • Minot
    • Williston
    Press
    Enter
  • 22
    In the event your desired clinic is full, we can get you scheduled at any clinics you select below. Please select all that apply.
    Press
    Enter
  • 23
    We'll try our hardest to get you scheduled at the clinic you select.
    • Albuquerque Encino
    • Albuquerque Osuna
    • Albuquerque Gateway Center
    • Farmington
    • Las Cruces
    • Rio Rancho
    Press
    Enter
  • 24
    In the event your desired clinic is full, we can get you scheduled at any clinics you select below. Please select all that apply.
    Press
    Enter
  • 25
    We'll try our hardest to get you scheduled at the clinic you select.
    • Albany
    • Bend
    • Corvallis
    • Eugene
    • Hillsboro
    • Redmond
    • Salem
    • Springfield
    Press
    Enter
  • 26
    In the event your desired clinic is full, we can get you scheduled at any clinics you select below. Please select all that apply.
    Press
    Enter
  • 27
    We'll try our hardest to get you scheduled at the clinic you select.
    • Arlington
    • Auburn
    • Bellevue
    • Bellingham
    • Edmonds
    • Everett
    • Longview
    • Maple Falls
    • Marysville
    • Monroe
    • Mt. Vernon
    • Northgate
    • Olympia
    • Puyallup
    • Renton
    • Tacoma
    • Vancouver
    Press
    Enter
  • 28
    In the event your desired clinic is full, we can get you scheduled at any clinics you select below. Please select all that apply.
    Press
    Enter
  • 29
    Press
    Enter
  • 30
    Press
    Enter
  • 31
    Press
    Enter
  • 32
    We are required to ask this question for insurance verification purposes.
    Press
    Enter
  • 33
    Pregnant women are welcome at Ideal Option. We ask this question to ensure pregnant women are given priority with scheduling.
    Press
    Enter
  • 34
    Press
    Enter
  • 35
    We won't be able to schedule your appointment without a valid phone number.
    Press
    Enter
  • 36
    We won't be able to schedule your appointment without a valid email address.
    Press
    Enter
  • 37
    We cannot guarantee same-day appointment requests using this online form. If you would like to be seen today either in clinic or remotely, please text 888-465-2488.
    /
    Pick a Date
    Press
    Enter
  • 38
    Please select one or more options. We will do our best to schedule your appointment in the timeframe you choose.
    Press
    Enter
  • 39
    Press
    Enter
  • 40
    We won't be able to schedule your appointment until we have your health insurance information. If you don't have insurance, please enter "uninsured" and a financial counselor will contact you to discuss your options.
    Press
    Enter
  • 41
    Please provide your membership ID we can verify your insurance coverage. If you don't have it, please enter "unknown'".
    Press
    Enter
  • 42
    Please provide your SSN so we can verify your insurance. All data is encrypted and stored securely.
    Press
    Enter
  • 43
    Press
    Enter
  • 44
    Messages will include appointment reminders and scheduling questions. You can unsubscribe at any time.
    Press
    Enter
  • 45
    Please share any information that will help us give you the best care possible.
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 46
    Press
    Enter
  • 47
    Please review the Notice of Privacy Practices (NOPP) found at the bottom of this page, and then check the box.
    Press
    Enter
  • 48
    By clicking the "I AGREE" checkbox, you also indicate that you accept financial responsibility, if any, for the Ideal Option services you receive. We may verify your insurance benefits and may submit a claim to your health insurer for payment. Without waiving your financial responsibility, you agree to assign your right to medical benefits to Ideal Option. If your health insurer does not pay your claim, or only pays a portion of your claim, you agree to pay the remaining charges. I authorize Ideal Option, PLLC to disclose to any third-party payor all necessary information and relevant portions of my patient record for the purpose of receiving payment for services rendered
    Press
    Enter
  • 49
    Press
    Enter
  • 50
    Press
    Enter
  • 51
    Press
    Enter
  • Should be Empty:
Question Label
1 of 51See AllGo Back
close