If you are unable to get through to your provider’s office by telephone or do not have telephone access, consider submitting the online form below. Your completed form will be emailed directly to your provider's office, who will be regularly monitoring these messages on a daily basis Monday through Friday during normal business hours only.

There is no need to re-submit the form if you do not hear back right away. Please note that while we will try to meet your preferred appointment date/time, we may offer you another option that matches with your provider’s earliest availability.

Your provider will determine the most appropriate type of visit for your concern, either Televisit or in office.