Request an Appointment

Use our online form to request an appointment for a procedure your doctor has ordered. Please note that this is only an appointment request. One of our customer care agents will contact you to schedule your appointment according to your preferred date, time & location and based on availability.

To request an appointment, please fill out the form below or call 860.289.3375

We will contact you to confirm your appointment date and time.
First name
Last name
Phone - -
Email
Your address and date of birth helps us identify you when scheduling the appointment
Date of Birth - - (mm-dd-yyyy)
Address
Address 2
City
State
Zip
Please select your preferred time and up to two (optional) alternate times in case your preference is not available
Date
Time
Date
Time
Date
Time

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