Request An Appointment If you are having a medical emergency and need immediate medical attention, please call 911 now.Please fill out the form below to schedule an appointment. We will respond to your request as soon as possible. Name* First Last Birthdate* MM DD YYYY Contact Phone*Secondary PhoneEmail* Select Physician*Darryl Hein M.D.Stacey Hein M.D.Reason for Appointment*New patient appointmentUrgent/Acute care - I need to be seen todayNew medical problem, not urgent. I am an established patientFollow-up appointment for ongoing medical issueSchedule an annual screening/complete physical examReschedule an existing appointmentPreferred Date*TodayThis WeekNext WeekNext AvailablePreferred Day of the Week*MondayTuesdayWednesdayThursdayFridayNo PreferenceTime Preference - 1st Choice9-10am10-11am11am-12pm2-3pm3-4pmTime Preference - 2nd Choice9-10am10-11am11am-12pm2-3pm3-4pm