Patient Name:

Which health care provider do you want to see? Matt Burkley, MD Mary Reeves, MD Joel Schaler, MD Bob Stroheker, MD Mike Bonnet, PA-C Charlotte Karls, PA-C First Available Provider

Preferred time of day for appointment? Morning Afternoon Evening Weekend

If you need a same-day appointment, please call us at 539-6637 or 539-6638 so we can arrange something immediately.

Reason for visit? Physical exam Follow-up visit Pregnancy visit Well-child exam Injury Skin check/procedure Cold/Respiratory symptoms Other

Contact information - We will contact you between 2:00 and 3:00 p.m. the day of your e-mail or the following day if your e-mail is received late afternoon. We will contact you on Monday between 2:00 and 3:00 pm if you send the e-mail over the weekend. Please provide telephone number(s) where you will be available between 2:00 p.m. - 3:00 p.m.

Preferred phone number:

Second option (if needed):

Notes: *

* THIS SITE IS NOT SECURE NOR HIPPA COMPLIANT. PLEASE DO NOT PROVIDE ANY MEDICAL INFORMATION ON THIS PAGE. This service is only for making appointments.