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:
Are you an employee/family member of our medical center?	Yes No

	*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 8:30 am to 4:30 pm.
	or

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