Emerald City Medical Arts - Appointment Request Form

Appointment Request

We are open five days a week,
Monday – 7:30 a.m. to 7:00 p.m.
Tuesday – 7:30 a.m. to 5:00 p.m.
Wednesday – 7:30 a.m. to 5:00 p.m.
Thursday – 7:30 a.m. to 5:00 p.m.
Friday – 7:30 a.m. to 5:00 p.m.
We charge $25.00 for missed appointments without 24 hours notice.


Name:
E-Mail:
Phone number:
Request appointment:	date time am pm
	If you do not need a specific date and time, specify what days and times would be convenient for you.
Other instructions:

As soon as we receive your request, we'll call you to confirm your appointment. If you are a new patient, please fill out the new patient registration form. Thank you.