ER Appointment Request

All fields must be entered before submitting your request.

First Name

Last Name

Email Address

Confirm Email Address

Phone Number

Schedule Date/Time

We will strive to have you triaged by a registered nurse within 15 minutes of your scheduled time, but we cannot guarantee your appointment. All patients coming to the ER will be triaged and treated in order of priority. If your condition worsens or if you feel you need assistance right away, then please go to the nearest emergency room or call 9-1-1.

I have read and agree with the statements listed above