Appointments Please use this form only to request an appointment. Do not send private health information here. Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!Name*Phone*Email* Preferred Date* Preferred TimeEarly MorningLate MorningEarly AfternoonLate AfternoonNature of VisitPhoneThis field is for validation purposes and should be left unchanged.