Request an Appointment

This form is for new patients seeking assistance scheduling an appointment. Complete the following information for the person needing the appointment:

 

Doctor Name:

*First name:

*Last name:

*Date of birth (mm/dd/yyyy):
*Phone number:
*E-mail address:
Reason for appointment/Symptoms:   
Are you an employee/family member of our medical center?
 
   
  *indicates a required field  

Our staff will contact you by telephone to establish your appointment.

  

 

Quick Reference

New Patient Appointments

Phone 336-716-WAKE
Or 336-716-9253
Toll-Free 888-716-WAKE

Ways to Give
USNWR 2013-2014Magnet Hospital RecognitionConsumer Choice2014 Best DoctorsJoint Commission Report

Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.