Request Appointment

You have the option of sending a request electronically.  Please note that this form is to request (not schedule) an appointment. Upon your submission, our scheduling staff will receive an electronic notification with the information that you have provided.  A representative will contact you within 24 hours of receiving your request. For requests submitted after business hours, you will be contacted the next business day.  Your desired exam date should be at least one business day from the current date.  In addition, if there is a preferred time of day you would rather us to contact you, please include that information in the description.