Appointments Pay Now Please complete the following form to request an appointment. DO NOT send personal health information through this form. Your reasons for seeking consultation and care will be addressed during an initial phone call to plan for your first appointment. Appointment availability will vary depending on your request. Please allow two business days for a response, at which time an appointment will be confirmed. Thank you!Name* First Last Phone*Email* Preferred Date* Date Format: MM slash DD slash YYYY Preferred TimeMorningAfternoonEveningNature of VisitCAPTCHANameThis field is for validation purposes and should be left unchanged.