Online appointments must be made three working days in advance. Online appointments are most convenient for well women, well man, well baby, annual visits, physicals, etc.

Thank you for choosing our practice for your medical needs. We value our relationship with you and want to serve as your “personal medical home.” Unfortunately, due to some insurer’s payment policy, we may have to complete your wellness care and your illness care in two separate visits. If you have a health problem you want to discuss with your doctor during your well visit, the doctor may decide to treat that problem and ask you to schedule another appointment for your well visit. We realize the inconvenience this may cause and regret that your insurer’s payment policy has led us to make this business decision. Your understanding of this situation is appreciated.

NOTE: Please remember we are no longer taking new Medicare or Medicaid patients

We require that our patients fill out a revised registration form every 6 months. If it has been 6 months since your last visit, please click here and you can download the form and bring it in with you to save some time on your next visit. Thank you. Also click here to print out the pre-exam checklist to give to your physician when you come in.

Patient Last Name: Patient First Name:
 
Street Address:



City: State: Zip:

Home Phone: Work Phone:

Email: Date of Birth:

Provider: [Please select a provider to specify date/time requests]

All appointment requests must be at least 5 days from today. The earliest date you can request is: 5/14/2008. Please pick a different date for each option.
Option #1 Date: Time:

Option #2 Date: Time:

Option #3 Date: Time:

Insurance:

Who is the insurance subscriber?

Reason for visit: