Request an Appointment

To request an appointment, please complete the form below. IMPORTANT: Our staff will contact you by phone to confirm the actual date & time of your appointment. *If this is an urgent or same day appointment request, please call the number below to schedule.

To request an appointment by phone, please call 952-946-9777.

First & Last Name:
Age:
Street Address:
City, State & Zip Code:
Which physician are you requesting?
How did you hear about us?
Comments or questions:
*You must enter a Phone number and E-Mail address for your form to be processed!

Your E-Mail address:
Phone Number:
Yes, I would like to receive your Special Offers by e-mail