What kind of insurance do you have? *

How long has the wound been present? *

Less than 2 weeks

2–4 weeks

Over 4 weeks

Not sure

Do you have any of the following health conditions? *

Do you prefer to receive care in our clinic or at your home? *

In-Clinic Visit

In-Home Visit (Mobile Care)

Get Your Results & Next Steps

Thank you! Once you complete the details below, we’ll compile your results and send you a personalized summary along with expert recommendations.

Full Name *

Phone *

Email *

Zip Code *

I agree to be contacted by Active Integrated Medical Center about my wound care options.