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Request an Appointment

This form is for NON-URGENT APPOINTMENTS ONLY.

User Privacy Rights

Please complete the information below. Once submitted, our office will contact you within one business day to schedule your appointment. If you have an emergency, call 911 immediately or go to your nearest emergency room. We do not respond to emergencies through this website.

*Required Field

Step 1: Select a Provider or Specialty
Specialty or Doctor Name*
Specialties
Providers
Step 2: Select a location

location
Step 3: Enter your information

First Name

Last Name

Date of Birth

Month(MM) of your date of birth

Day(DD) of your date of birth

Year(YYYY) of your date of birth

Phone Number

first 3 numbers of phone number

second 3 numbers of phone number

last 4 numbers of phone number

Are you a new or existing Florida Medical Clinic Patient?

New
Existing

Comments
Comments

Request an Appointment

User Privacy Rights

Step 1: Select a Provider or Specialty

Step 2: Select a location

Step 3: Enter your information