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