Appointments - Connect Medical Clinic

If you would like to request an appointment to visit our clinic, you may do so using the form below. One of our staff members will contact you to set up your appointment date and time.

NOTE: If we receive your request after close of business on Thursday, one of our staff members will follow up with you after we reopen the following Tuesday.

All contacts are confidential to the extent allowed by state law. While your message will remain confidential, please note electronic messages have inherent privacy risks.

Appointment Request Form

Name*
First Last
Email Address*
Phone Number*
Is the above number a cell phone?*
Preferred Method of Contact*
- Phone Call
- Text Message
- Email
- Any of the above
What are the best times and days to contact you?*
Requested Service*
Any special instructions or notes for Connect Medical Clinic?