We cannot schedule "same day appointments" via this website; however, same day appointments may be available. Please call our office if you want an appointment today. Also if this is a medical emergency, please do not fill out this form, call 911.

Please be aware that you are submitting a request only. A representative from our office will contact you within 24-48 business hours and confirm a date and time.

*First NameFirst Name is required. *Last NameLast Name is required. *TelehealthTelehealth is required. Yes No *Date of Birth *SexSex is required. Male Female *AddressAddress is required. *CityCity is required. *StateState is required. *Zip CodeZip Code is required. *Phone NumberPhone Number is required. Please format as phone (555) 555-5555Cell PhonePlease format as phone (555) 555-5555 *EmailEmail is required. Invalid E-mail  *Type of PatientType of Patient is required. New Existing *Type of AppointmentType of Appointment is required. New Exam Follow Up Reason for Appointment Choose... Hormones Testosterone Thyroid Weight Loss Well Women Exam Other Who may we thank for referring you?Referring Physician *Preferred DayPreferred Day is required. Choose... First Available Monday Wednesday Thursday *Preferred TimePreferred Time is required. Choose... First Available Early Morning Mid Morning Afternoon *Date of Request Additional Comments