All fields are required unless they state optional
Please correct the errors described below.
This field is optional
Optional, leave this field empty for first available provider
Your information will be encrypted.
About the Go2Dr™ Patient Appointment Request Form
We created the Go2Dr™ Patient Appointment Request form to make it easy for patients to request appointments when it’s most convenient for them. Patients can request an appointment on safe, secure servers.
Why Use Go2Dr™?
It's free to request the appointment!
It allows you to request a medical consultation online at a time that's convenient for you, including evenings and weekends.
It's safe and secure.
What Happens After I Submit an Appointment Request?
The designated contact for the participating healthcare provider receives an email alert once a new request is submitted and signs on to a secure web portal to view the appointment request.
Tell me about my Go2Dr™ Appointment Request
Free of charge. Always.
Hosted on secure servers.
Your browser does not support capabilities required for electronic signatures.