Orland Primary Care Appointments

Non-urgent appointment requests can now be made online. By using this online tool, making an appointment has never been easier. Simply complete the required fields and wait for our appointment desk to return your request with several options that fit within your preferred date and time. Required fields are marked with an asterisk.

Patient Info
First name:		*
Middle initial:
Last name:		*
Gender:		*
Birth date:		(mm/dd/yyyy)*
Primary phone:		*
Alternate phone:
Best time to reach you:
Contact Info (If other than the patient)
Contact name:
Relation to patient:
Phone:

Appointment Details
Reason for appointment:
If other please provide a reason:
Are you a new patient?:		*
Requested physician:
Have you seen this physician before?:
Preferred Appointment Date and Time
Preferred day:		*
Preferred time:		*