This form permits one appointment request per submission. Please submit a single form per appointment requested. If you are a current patient, please use our patient portal or call your provider for non-appointment service requests.Remember to provide a valid phone number so a team associate can follow up via phone to verify your appointment and collect any additional information.
Note: should be used for non-urgent appointments only. If you need immediate assistance, contact your provider’s office right away. The information provided will remain confidential and will not be allocated in your medical record. Information provided will only be used by our administrative staff to service you with scheduling your appointment. We request you allow up to 24 hours or one business day for us to contact you.
In accordance with guidelines suggested by the American Medical Association, please acknowledge the following when communicating by email with any physician:
- Please understand that emergency needs cannot be met by email and that email is not checked on a regular basis. Urgencies should be referred to the office or the 24-hour answering service. Emergencies should be handled by calling “911.”
- If the problem that you plan to email is complicated or long, it would be better for you to schedule an appointment with one of our physicians. If you email an extremely complex problem, we may email you back and ask you to schedule an appointment.
- Security of email messages is limited by your server, computer, software, browser, and access to your system. Security is appropriately controlled on our website and email system.
- Email is not a substitute for an office visit and/or physical examination. It is only a convenient means of introduction or communication to handle simple needs, questions, or drawing attention to various aspects of your care.
- Copies of your email correspondence will be kept in your chart.
- If you abuse your email privileges, such electronic interaction may be terminated at any time, by email filters and your messages will not be read.