Request an Appointment

******NEED TO BE SEEN TODAY? SEE THE MAP BELOW FOR DATES AND TIMES OF OUR EXTENDED HOURS CLINIC.******

Dial 911 for emergencies

"*" indicates required fields

First Name*

Middle Name

Last Name*

Date of Birth*

Daytime Phone*

Evening Phone

Choose one or both of a particular physician you prefer, or a specialty you need.

Select a Physician

Select a Specialty

Reason for Appointment*

No other services should be requested here.

Disclaimer*

I agree to the following disclaimer:

THIS FORM SHOULD NOT BE USED TO COMMUNICATE WITH THE PHYSICIAN'S OFFICE. ANY REQUESTS FOR SERVICES OTHER THAN TO MAKE AN APPOINTMENT WILL NOT BE PROCESSED. PLEASE USE OUR PATIENT PORTAL OR CALL YOUR PROVIDER FOR NON APPOINTMENT SERVICE REQUESTS.

This form allows one appointment request per submission. Please submit a form for each appointment requested.

Please allow 24 hours or one business day for us to contact you.

The information provided will remain private and confidential and will not be placed in your medical record – it will only be used by our administrative staff to assist you with scheduling your appointment.

This form should be used for NON URGENT appointments only. If you need immediate assistance, contact your provider’s office directly.

Please provide a valid phone number as Gessler Clinic will follow up via phone call to confirm your appointment time and any additional information that is needed.

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Request an Appointment

MAIN CLINIC

Find A Doctor

Make An Appointment

Patient Portal

Pay My Bill

PATIENTS & VISITORS

ABOUT

Call Gessler

Find A Doctor

Location