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Request an Appointment

Do you want a doctor's appointment, but don't have time to call for one? Use this form to request an appointment.

If you would like to change or cancel an existing appointment, please click here.

CONFIDENTIAL MEDICAL COMMUNICATION
Request an Appointment is intended for use when requesting routine appointments. At this time, only selected specialties and physicians may be contacted using Request An Appointment. If you are seeking an immediate appointment or wish to contact a specialty/physician not listed on this page, please call the doctor's office. For a listing of office phone numbers, click Office Phone Numbers.

If you need urgent medical attention, call 911 or go to the nearest emergency room. Change/Cancel an Appointment

Please complete all required fields

Patient Info:

Patient First Name: *

Patient Last Name: *

Patient E-mail Address:

Patient Date of Birth: *

Daytime Phone:*
--

Alternate Phone:
--

Best Time to Call:
AM PM ANY

Primary Care Doctor:

Patient Insurance:*


Appointment Info:

Choose Practice: *

Preferred Appointment Day:
Mon Tues Wed Thu Fri

Are you a current patient of this practice?*
Yes No

Reason For Visit:(Up to 500 characters)
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The use of this form does not guarantee an appointment.
Follow-up contact with you must occur before an appointment date and time, if appropriate, is scheduled.





Important Note:

The Stony Brook Medicine University Physicians website is primarily an informational and educational resource. It should not be used in place of medical advice and recommendations you receive from your health care provider. If you have, or suspect that you have a medical problem or condition, please seek the advice of your health care provider.


Stony Brook Medicine University Physicians provides marketing advice and consultation to the clinical Faculty associated with the University Faculty Practice Corporations (UFPCs). It does not provide medical care directly or indirectly nor does it oversee, direct, manage or supervise the medical care provided by any of the individual Practices. The individual Practices are responsible for the medical care each Practice provides to its patients. Please note that the Practices listed below are separate University Faculty Practice Corporations (UFPCs).