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6 Fieldstone Commons, Suite ETollandCT06084
(860) 896-4848

Request an Appointment

Use our online form to request an appointment for a procedure your doctor has ordered. Please note that this is only an appointment request. One of our customer care agents will contact you to schedule your appointment according to your preferred date, time & location and based on availability.

Your Contact Information
We will contact you to confirm your appointment date and time.
* = required fields

Name(Required)
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Address
Appointment Type
Please select the type of appointment you would like to book.
Date and Time
Please select your preferred time and up to two (optional) alternate times in case your preference is not available.
MM slash DD slash YYYY
Time
:
Alternate 1 (Optional)
MM slash DD slash YYYY
Time
:
Alternate 2 (Optional)
MM slash DD slash YYYY
Time
:
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