Physician Appointment Scheduling

***If this is an emergency or you are experiencing chest pain, shortness of breath, or an allergic reaction, please call 911 or report to your closest Emergency Room immediately. Do not use this form for urgent medical needs.

Inspira Health offers easy ways to schedule your appointment. You can make an appointment by calling 1-800-771-APPT (800-771-2778) or you can request an appointment online by completing the information below.

Please include the best telephone number including area code or email address for us to reach you so we may finalize your appointment.

**Do not use this form for COVID vaccine scheduling**

First Name

Last Name

Telephone

Email Address

Date of Birth

Preferred Primary Care Office

Interpreter Needed

May we send you health information by email?

Yes

Math question 12 + 5 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.