Please use this form to
submit an appointment request. Once the appointment is scheduled, you
will receive a confirmation email requiring a response. If you do not
respond to the confirmation email (or if you don't have an email
address), we will call you to confirm the appointment. In the event we
are unable to contact you via email or phone within reasonable time,
the appointment will be cancelled.
Online Form Security
meet the security and privacy standards set by HIPAA, we utilize
Secure Socket Layer (SSL) technology to secure this transmission.
SSL is the industry standard security protocol. SSL creates a
shared digital key, which only lets the sender and the receiver of
the transmission scramble or unscramble information. To everyone
else, the SSL transmission is indecipherable. This is the same
level of security used by financial institutions and popular
online retail outlets to secure sensitive data. Although no
security process is 100% secure, we will continue to use the
latest technologies available to ensure that our patient's private
health information is protected to the fullest extent possible.
Most modern browsers
will display an image of a closed lock or an unbroken key and a
URL beginning with HTTPS indicating a secure session has been