Request a Visit Family Medicine Lab Work Medication Dispensary Weight Loss Program Request a Visit Request a Non-Urgent Medical Appointment Do Not use this form for any urgent medical issue, dial 911 for emergency care.If signed up, existing patients can easily request an appointment through our Patient Portal. Patient's First Name Patient's Last Name Email address: Telephone Date of Birth: Patient Type Existing Patient New Patient Person Requesting Callback Time Morning Afternoon No Preference Preferred Appointment Date Send