Appointment Request for Baylor Family Medicine at Fort Worth

Welcome to our online appointment scheduling. We will make every effort to accommodate your request.
Please note, however, only routine appointments should be requested online.

In an Emergency, Call 911.

If you have an Urgent medical need, or are seeking a same-day appointment, please call our office.

Required items are marked with a red asterisk*

Patient's Last Name: *
Patient's First Name: *
Patient's Middle Name or Initial:
Date of Birth: * (mm/dd/yyyy)
Daytime Phone Number: * (000-000-0000)
Evening Phone Number: * (000-000-0000)
Cell Phone Number: (000-000-0000)
Are you a new Patient?
Insurance Type:
Who is Your Provider? *
Are you willing to see another physician in order to get the date or time requested?
Which is most important to you?
Purpose of Visit: *
Describe Symptoms (Illness only):
Person Making Appointment: *
Relationship to Patient: *
Return E-Mail Address: *

Schedule Preference:
Select the days which you are available and we will attempt to match your request with your physician's schedule.

The office may not be open on all days listed. The earliest date that an appointment might be available is 3 working days from today's date, depending on the physician's schedule. Please do not select Saturdays or Sundays. This will allow us enough time to confirm your appointment request.

Hours of Operation:
Preference Date Time
1st: *
2nd: *
3rd:
4th:
5th:

Additional Comments: