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    Request An Appointment


    Our online request an appointment feature is for patients who would like to schedule a future appointment and is not intended for same day appointments. If you need an appointment today, please contact your physician practice directly.

    Your request will be sent to a Novant Health representative who will contact you to assist in scheduling an appointment.

    If you are having a medical emergency and are in need of immediate assistance, please call 911.
    Steps:
    * denotes required fields

    Appointment Information

    Specialty
    Physician Requested (optional)
    or
    Location-First Choice (optional)
    Location-Second Choice (optional)
    (Use the fields below to indicate your preferred day and time for an appointment.
    We will do our best to accommodate your preferences. You will be contacted to confirm your appointment day and time.)
    Preferred Day *
    Preferred Time *
    Reason for doctor visit
    * denotes required fields

    Patient Information

    First Name *
    Last Name *
    Address *
    City *
    State * Zip *
    Daytime Phone
    Evening Phone
      Best time to be reached
    Email Address *
    Preferred method of contact *
    Gender
    Date of Birth
    Health Insurance
    If Yes:

    Requestor's Information

    Same as patient's information
    First Name *
    Last Name *
    Daytime Phone
    Evening Phone
      Best time to be reached
    Email Address *
    Preferred method of contact *