Request an Appointment

To make an appointment with one of our physicians call our office 651-221-9051. You may also request appointment online by submitting the form below. After you submit the request, our scheduling department will contact you within one business day with details of your appointment. In order to expedite scheduling, please fill out all fields.

Please note that this form is only intended to help you schedule an appointment with our physicians. For care-related questions, call 651-221-9051 or sign up for our HIPPA compliant patient portal to securely communicate electronically with your physician. Call our office if you are interested in signing up for the patient portal. Thank you.

Patient and Appointment Information
First Name
*
Last Name
*
Date of Birth (MM/DD/YYYY)
Referring Physician
Reason for Visit:
*
*
Maplewood Clinic
Saint Paul Clinic
No preference
AM
PM
No Preference
Phone Number
*
Email