New Patients

You're in great hands

We make sure all our new patients feel welcome, safe, and taken care of. During your first visit, a team member will review your surgical and medical history. A complete history and targeted physical examination will also be performed. Please bring in all old imaging and medical records.

For a shorter time in the waiting room, please forward imaging studies and records to us before your visit.

Book Your First Appointment:

Use this form to request an appointment. This is a secure site that protects your personal information.

You will receive priority by using this method and we will call you to confirm.

Name

First Name

Last Name

Phone

(###)

###

####

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Care Physician

Are you a new patient?

Yes

Date Requested

YYYY

Time Requested

Note: We are open from 10 AM to 4 PM on Fridays.

Insurance Provider

Workers' Compensation

(if applicable)

No Fault Insurance

(if applicable)

Emergency Contact Information

Imaging

Check all that apply.

I have imaging at home.

I had imaging done at St. John's Riverside Hospital.

Comments or Questions:

Cancellation Policy: To avoid a $50 fee, notify us at least 24 hours prior to your appointment to cancel or reschedule.