Schedule An Appointment Does your condition fit the requirements for Telehealth appointments?* Yes (I have read the list of qualifying conditions and/or symptoms) I'm not sure (screening over the phone may be required) Your Name* First Last Patient Date of Birth* In order to reserve an appointment slot for patients, we will need a date of birth.Phone Number (Appointment Confirmation)*Please provide a phone number where we can reach you to confirm our available appointment dates and times.Email Address* Which day(s) of the week are you available for an appointment?* Monday Tuesday Wednesday Thursday Friday Please select all days that you are available or prefer to have an appointment.What time(s) of the day are most convenient for you?* Early Morning (8:00 - 9:45am) Late Morning (9:45 - 11:30am) Mid-day (11:30am - 1:15pm) Early Afternoon (1:15 - 3:00pm) Late Afternoon (3:00 - 4:45pm) Early Evening (4:45 - 5:45pm)** Select all time slots that are possible for you to come in to our primary care clinic. ** Please note that we do offer extended clinic hours until 5:45pm on certain days of the week!Any comments / questions concerning an appointment?Let us know if there are any questions we can answer before your appointment (i.e. whether we accept your insurance provider, health share program, etc.). We cannot answer specific medical questions through this form! This iframe contains the logic required to handle Ajax powered Gravity Forms.