Please make note that all information must be filled out as this form allows CCMD to evaluate if our services are appropriate for your medical needs. After it is submitted and reviewed you will receive a response and offered an initial consult appointment with Dr. Blossom if appropriate. This initial consult is in person and includes a more thorough discussion of your medical history and lifestyle goals. The in person initial consultation fee is $250 and must be paid in advance of your appointment. If after the initial consult it is agreed by both the patient and Dr. Blossom that Carlyle Concierge Medicine is the right fit for your needs then the $250 deposit is subtracted from the annual fee of membership.