Contact Us Contact Us If you have a Medical Emergency, please Call 911 or Visit the nearest Hospital / Emergency Room. Subject * How may we help you?New Patient Appointment RequestExisting Patient Appointment RequestExisting Patient Prescription Refill Request Subject Tele Visit Options * Video Visit – I have a smart phone or computer with a camera In-Person Either is Okay Note: Prescription refill requests should be entered 3 Business days before your medication runs out to give us enough time to setup a follow-up visit or, if possible, to call in your medication(s) to the pharmacy. Patient Name * First Last * Last Patient Date of Birth * Phone * Phone Email * Email If you are human, leave this field blank. Next