Request an Appointment

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

If this is an emergency, please call 911.

*First name:
*Last name:
*Date of birth (mm/dd/yyyy):
Address:
Address:
City:	State: Zip:
*Phone number:
E-mail address:
Reason for appointment/Symptoms:


	*indicates a required field

Our staff will call you on the first business day after you submit this form. Call Center hours are 8:00 am to 5:00 pm, Monday - Friday. Thank you!
	or

	If you prefer, you may reach us by phone at 336-716-WAKE or 888-716-WAKE (9253).