Please use this form to request an appointment.

You may also contact our office at (928) 526-2423 or email us at [email protected].

  • Submitting this form does not guarantee or secure an appointment. We will contact you to confirm your visit. Please do not use this form in an emergency.
  • After submitting this form, please wait to hear back from us before heading in for your visit. Please note that this form is not intended for emergencies or urgent requests.