Request an Appointment

Please provide the name of the patient that you are requesting the appointment for.  If this is a child, please provide parent or guardian name in the comment box.  
If you have insurance you would like to use for your visit, please provide that information in the comment box below.  We need the insurance name, primary member name, ID number, as well as a good contact number for the patient.  If we are not an in-network provider, or if you are not eligible for services, we will contact you at the number provided.  Also, if you have an HMO, you will need to contact your primary care physician for a referral before your appointment date.  Thank you.

Contact information

Name
Phone

Appointment details

Date
Time
I'm making an appointment for
Comments and Questions
Maximum of 250 characters

Please note that the date and time you requested may not be available. We will contact you to confirm your actual appointment details.

1234 Bay Area Blvd.
Suite E
Houston, TX 77058

Mon: 8:00AM - 6:00PM

Tue: 8:00AM - 7:00PM

Wed: 8:00AM - 6:00PM

Thu: 8:00AM - 5:00PM

Fri: 8:00AM - 12:00PM

Sat: 8:30AM - 11:30AM

Sun: Closed