Request an Appointment

A new patient? Need help finding a primary care physician or specialist?

If this is an emergency, please call 911.   

Doctor Name: 
*First name:  
*Last name:     
*Date of birth (mm/dd/yyyy):
City: State:   Zip:
*Phone number:
 E-mail address:
Reason for appointment/Symptoms:  
Are you requesting a same day/next day appointment? (Available for primary care and orthopaedic services appointments only.)  
  *indicates a required field  
Our staff will contact you by telephone to establish your appointment. A call will be made to you on the first business day following your submission of this form. Call Center hours are 8:00 am to 5:00 pm.  
  If you prefer, you may reach us by phone at
336-716-WAKE or 888-716-WAKE (9253).