To schedule an appointment, please call our office at 760-753-ENDO (3636) during our business hours (see below) or use this form.

Type of Visit:	New Patient  Follow Up
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PLEASE NOTE: This page is not HIPAA Compliant - please do not enter specific medical information, only general information in the box above.
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Referring Physician:	Name: Phone:             Please include area code
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Please indicate which 3 days are best for your appointment
Office Hours: Tues-Wed-Thurs: 8:30am-5:00pm
1st Preferred Date/Time:	(enter like MM/DD)   9:00am 9:30am 10:00am 10:30am 11:00am 11:30am 1:00pm 1:30pm 2:00pm 2:30pm 3:00pm 3:30pm 4:00pm 4:30pm
2nd Preferred Date/Time:	(enter like MM/DD)   9:00am 9:30am 10:00am 10:30am 11:00am 11:30am 1:00pm 1:30pm 2:00pm 2:30pm 3:00pm 3:30pm 4:00pm 4:30pm
3rd Preferred Date/Time:	(enter like MM/DD)   9:00am 9:30am 10:00am 10:30am 11:00am 11:30am 1:00pm 1:30pm 2:00pm 2:30pm 3:00pm 3:30pm 4:00pm 4:30pm
We will contact you with the first date/time that meets your preference. If none of your preferences can be met, we will contact you with other open appointment times.

If you need to cancel or reschedule your appointment for any reason, please give us 48 hours notice. It is our policy to charge for appointments that are missed, or those not cancelled within 48 hours. Insurance does not cover these charges.

All Co-pays are due upon check-in. Credit cards, checks or cash are accepted and we will give you a receipt.