Patient Services Make an Appointment Make an Appointment Prescription Refill Request Test Results Ask a Billing Question Information Sheet Urodynamic Testing Forms   Office Hours Office hours are 8am to 5pm Monday through Thursday and 8am to noon on Friday. The office is closed on major holidays. Patients are seen by appointment only and may be scheduled during our routine office hours. If a problem will delay or postpone your appointment, we will contact you whenever possible. We ask for your patience when delays occur; this is the nature of any obstetrical practice. If you have a disability that requires special needs, please contact our receptionist prior to your appointment date. Surgery is scheduled according to your medical need, the doctor’s schedule and the hospital’s availability once insurance is approved. Our staff schedules pre-operative visits and labs. Our strict patient confidentiality code requires authorization from our patient in order to release any information even to a family member. Our office is located on the first floor of the Physician’s Plaza, which is attached to Methodist Medical Center. Patient First Name: Middle Initial: Patient Last Name: Patient Contact Information Primary Phone: Secondary Phone: Email: Mailing Address:  City: State: Zip Code: Date of Birth (mm/dd/yyyy) : Social Security Number: Insurance: Name of Insured: Plan ID #: Preferred Response: Email Phone Clinician: Location: I am a new patient to your practice: Yes No Please Select One: Make an Appointment Cancel an Appointment (date of original appt.) Reschedule an Appointment (date of original appt.) Cancelation Comments: For a new appointment, fill out the following section. Call the office for any urgent medical problem that needs to be addressed today. Type of Visit: Annual Exam Other Post-Op Postpartum Prenatal Procedure Specific Problem Please state other comments or scheduling requests: Schedule appointment for: First Available Preferred Date (mm/dd/yyyy) Preferred Week or Month Preferred Day (select all that apply): Any Day Monday Tuesday Wednesday Thursday Friday Preferred Time (select all that apply): Any Time Early Morning Late Morning Early Afternoon Late Afternoon     Copyright © 2008 OB-GYN ASSOCIATES of Oak Ridge, P.C.. All rights reserved.