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$pat_name is scheduling an appointment for $date at $time with $res_name for $appt_type.
This appointment request is contingent upon approval by the practice. You'll receive an e-mail confirmation once your information has been validated and your appointment request approved. If you have any questions in the meantime, please don't hesitate to contact the office at 718-650-6018 Ext 148.
Please review the information above prior to submitting this form.
Thank you $pat_name for requesting an appointment at $practice_name! Your appointment request has been successfully received and will be processed as soon as possible. We may reach out to you if we have any questions or require further details from you.
Your requested appointment is for $date at $time with $res_name for $appt_type.
Your portal username is $user_name. Once your appointment has been approved, you'll be able to login to your online patient portal account.