Request An Appointment

• Patient Information

• Name*
  First Last
• Date of Birth*
  MM slash DD slash YYYY
• Email Address*
• Phone*

• Insurance Information

• Health Insurance Plans*

• Appointment Information

• Are You a New Patient?*
  Please Choose OneYesNo
• Consent
  I agree to receive an email or phone call for feedback questions.
• Preferred Appointment Time*
  Please Choose OneMorningAfternoon
• Select a Provider*
  Please Choose OneDr. Roger Dunteman – Sports Medicine (Shoulder & Knee)Dr. William Sims – Sports Medicine (Shoulder, Elbow & Knee)Dr. Douglas McInnis – Joint replacements of the Hip & KneeDr. Jon King – Sports Medicine (Shoulder, Elbow & Knee)Dr. Scott Brown – Foot and AnkleDr. Gregory Keese – Hand, Wrist & ElbowDr. J. Luke Smith – Joint replacements of the Hip & KneeNo preference – Place with most appropriate provider
• Reason for Visit/Appointment*
  Please Choose OneShoulderHipElbowKneeWristAnkleHandFootUpper ArmUpper LegLower ArmLower Leg