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medical appointment request

This form is provided as a convenience for those who are unable to log in to the portal, or for those who have difficulty picking an exact date after logging in and using the "appointments" function. Log in to the portal if you can. (Inside the portal you can pick an exact date and time.)

This form allows you to request a non-urgent appointment. An appointment is not guaranteed with this request until you receive a reply with an actual appointment time.

Call the office or seek alternate care if your concern is urgent.

(Not required if on file, but handy if you are looking for an appointment soon.)
If new or changed. Established patients can skip if unchanged.
e.g. new problem, old problem, physical? Keep it short.

Our office is generally open Monday - Wednesday from 9:00 - 12:30 and 1:30 - 5:00, Friday from 9:00 - 12:30 and 1:30 - when I feel like going home.

(Use this if you are flexible about the time on that day.)

If that date doesn't work, give us a range of dates below if you wish, or use the comment field at the bottom of the form.

e.g. morning, afternoon, earliest or latest available?
Keep it short. We'll talk about it at the appointment.

Thank you for completing this form. Submit this form and await reply.

Your reply may be an actual appointment, or may be instructions to log in to the portal. (Once you are able to log in to the portal, you can pick or change your appointment yourself.)

Call the office if you have not heard from us in 3 working days, or if this is urgent.

* Required field