Request an Appointment at Scott & White
Before you begin, please note...
|This online appointment request service is for advance appointment scheduling only. For same-day appointment requests, please phone the Scott & White location you'd like to visit. For a medical emergency, please phone 911.|
|The information you provide in this form is secure and confidential. Scott & White respects your privacy.|
|*||Required information is marked with an asterisk (*) and must be completed before you can submit the appointment request.|
|Compatible Web browsers: This form is compatible with Internet Explorer 6.0 or greater or Firefox 3.6 or greater. You can click the link to either browser for a free download if you need it.|
What You'll Need to Complete This Form
- The patient's legal name, date of birth, home address and primary phone number
- The patient's preferred contact method (phone or email)
- For new patients of Scott & White who will be paying with insurance,
the patient's health insurance provider name, customer service phone number
and patient identification number
(View a list of accepted insurance plans)
Note: Scott & White also accepts payment by cash, check, Visa, MasterCard, American Express and Discover cards, money orders and travelers checks.
- The name of the patient's Scott & White primary care physician or the name of the Scott & White health care provider the patient would like to see (Find a provider)
- The patient's preferences for when to schedule the appointment