Appointment Scheduling

Physician E-mail

E-Mail: Patient confidentiality and our practice will use electronic mail on a limited basis to communicate with patients. We treat all communication between patient and provider with equal confidentiality whether by telephone, regular mail or electronic mail. Patient issues which we do not discuss via electronic mail are as follows:

  • protected diagnosis such as psychiatric conditions
  • results of HIV testing
  • work related injuries and disabilities

When communicating from work, you should be aware that some company’s consider electronic mail corporate property and your electronic mail message may be monitored.

WE RECOMMEND THAT YOU CHECK WITH YOUR COMPANY ELECTRONIC POSTMASTER BEFORE USING ELECTRONIC MAIL TO COMMUNICATE MEDICAL INFORMATION OR CONCERNS WITH OUR PRACTICE.

Doctor for Kids Schedule:

Monday's 8:30am - 5:00pm
Tuesday's 8:30pm - 5:00pm
Wednesday's 8:30pm - 4:00pm
Thursday's 8:30am - 5:00pm
Friday's 8:30am - 5:00pm
Saturday's 9:00am - 12:00pm
(October - March)

Please fill out the information below for appointment requests. There is no fee to request an appointment through this form..

If you are requesting a prescription refill, please click here.

Requested Date*: Requested Time*:

Reason for Appointment:

Please Contact Me Via:
Email Work Phone Home Phone Fax Mail

Your Name*:
Child's Name*:
Address:
City, State Zip:
Email*:
Work Phone*:
Home Phone*:
Fax:

By submitting this form, you accept the terms set forth above and understand that any communications may become part of the patient's permanent medical record. It is also understood that you have read our Privacy Policy and accept and understand the terms set forth.

Please allow a few seconds for this form to process. Do not hit Make Appointment a second time. You will receive a confirmation message when your form is submitted.

New Patient Information

Following are the forms required for new patients. Please print and fill them out in order to save time. Please remember to bring them to the office.

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