Make an appointment

An quality experience for our patients is very important to us. Please complete the form below to request an appointment. Once the form has been submitted, one of our receptionists will contact you within 72 hours to confirm and complete your appointment request.

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** IF YOU DO NOT RECEIVE A REPLY FROM OUR CLINIC WITHIN 3 business days, PLEASE CHECK YOUR JUNK/SPAM FOLDER **

(Please note that this is for NON URGENT APPOINTMENTS ONLY. in the event of an urgent medical matter you should call 911. You can also reach Tele-Care by dialing 811).

 *** IF YOU NEED TO FORWARD US SOME PHOTOS, PLEASE SEND THEM TO : CMNRV@CLINIQUEMEDICALENEPISIGUIT.COM. (PHOTOS ONLY. NO APPOINTMENT WILL BE GIVEN THROUGH THIS EMAIL ADDRESS ) ***

First Name:
Last Name:
Your doctor’s name:
Email Address:
Phone No:
Cellular or Other Phone:
Please select when... Please select when... 1-2 weeks 2-4 weeks 3-6 months
Please select reason... Please select reason... Follow up Complete exam (Pap test) Injection (B12, Allergies) Flushots Need a Family Doctor Other
Please contact me by: Please contact me by: Telephone Email
Message:

The receptionists will answer your request by phone or email within 24 hours of a business day.
Please be advised that if you need an appointment as soon as possible, you should either come at the clinic, call the clinic or call Telecare.

If this is an URGENT matter than you should go to the emergency department as soon as possible or call 911.