Request an appointment

Tell us what you need and when works for you. We'll confirm your time by text or email within one business day. Existing patients can also book instantly in the patient portal.

1 What kind of visit?

New patient visitFirst appointment with us Annual physicalWellness exam and screenings Sick or same-day visitSomething new or getting worse Follow-upResults, refills or ongoing care Child's visitWell-child, school or sports physical Video visitTelehealth from home

2 Who and when

Preferred provider

Preferred date

Preferred time of day

Morning Midday Afternoon Saturday

Reason for visit (optional)

3 Your details

First name

Last name

Date of birth

Mobile phone

Insurance (optional)

I agree to be contacted by phone, text or email about this request. See our Notice of Privacy Practices.

This form does not confirm a time. We'll reach out within one business day.

Prefer to call?

Our front desk books appointments during office hours and can usually find a same-day slot if you call before 11am.

[PHONE NUMBER]

Mon–Fri 8:00am–6:00pm · Sat 9:00am–1:00pm

What to bring

Photo ID and insurance card
A list of current medications and doses
Records from previous providers, if you have them
Questions you want to cover

New patients: please arrive 15 minutes early, or complete your forms in the portal beforehand.

If this is a medical emergency, call 911 or go to your nearest emergency room. Do not use this form.

Harbor Family Medicine

Primary care for the whole family. [STREET ADDRESS], [CITY, STATE ZIP].

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