Baptist Health System 1-877-222-7847
       
 


Please note that this form is to be used for NON-URGENT requests only. If you have an immediate medical concern, dial 911. If you are under the age of 18, please ask a parent before submitting any personal information online.

Our physician finder representatives are specially trained to put you in touch with the right physician, custom-matched, to your individual needs. We'll even save you some time and make the appointment for you, then call you back to confirm the details.

Just enter the information in the form below and we will contact you within 24 hours with all the details of your appointment! Required fields are marked with an asterisk. Additional information is required to schedule your appointment, but we will be happy to contact you for further information based on the contact information you provide, if you prefer.

indicates required fields

   
First Name:
Middle Initial:
Last Name:
Street Address:
City:
State:
Zip Code:  (xxxxx or xxxxx-xxxx)
Email address:  (John.Smith@bhsala.com)
Daytime Phone Number:  (xxx-xxx-xxxx)
Date of Birth:  (mm/dd/yy)
Insurance Provider:
Preferred Day(s) of the Week for Your Appointment: Monday     Tuesday     Wednesday    Thursday    Friday
Preferred Time of Day: Morning     Afternoon     Doesn't Matter
Is there a particular physician you would like this appointment scheduled with? Yes    No
If yes, please list the physician's name:
Description:
Please do not submit personal medical information, or request medical advice.
Comments:
Please do not submit personal medical information, or request medical advice.


1-877-222-7847