Please fill out this request for an appointment with as much information as possible.The submission process may take upwards of 30 minutes however this process will give us the appropriate information about whether or not we are able to meet your treatment needs. Incomplete forms will not be considered for appointments.
WE ARE NOT IN NETWORK WITH AHCCCS, MEDICARE, TRICARE, WORKERS COMP, EAP so please do not submit the form if you do.
Please note that submission of this form does not guarantee an appointment nor does it constitute a patient-physician relationship.
We are unable to see anyone under the age of 17.
Appointments are scheduled on a case by case basis based on Physician availability.
There is currently a wait list for new patients.