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 plan to use insurance for your visit, you MUST provide that information with your appointment request. Please provide: Insurance Name, Primary Member Name & date of birth, ID number, as well as a good contact phone number. If this information is not provided, your request cannot be processed online. In addition, if you have an HMO, you will need to contact your primary care physician for a referral. Thank you.