We need the following information sent in the body of your e-mail:
Your first and last name.
Your e-mail address.
A contact number for you, including area code.
Is this a referral? If so, by whom? Please give address and phone number of Doctor.
What is the problem that you are having and how long has it been going on?
If you are making this appointment for someone other than yourself, please state your relationship.
Any appointment time restrictions that you may have, for example work or school hours.
Let us know if you would like us to contact you for your appointment time by phone or email.
For your protection, please do not give any further information until we speak to you by phone or in person. If you request an email response, we will send you a confirmation e-mail to determine if you still desire an appointment within 48 hours. We will reserve an appointment time for you, and hold it for you. However, if we do not hear back within 24 hours of our response email, the appointment time will be forfeited.