Appointment Request

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Appointment Request

Meridian Harmonics Clinic of Oriental Medicine
2044 Bedford Road, Bedford, TX 76021
Text us at 682-292-8767 or email mtryling@gmail.com

E-mail *

First and Last Name *

Birthdate *

AAAA

Mobile Phone *

Clinic Appointment Times *

Prefer Morning 8:00 to 12:00

Prefer Afternoon 1:30 to 6:30

First Available

Obrigatória

First Available Appointments are 7-10 Days Out

If we get a cancellation we may contact you to see if want to come in earlier than your scheduled appointment.

Appointment Request Date *

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Appointment Request Time *

Horário

Alternate Appointment Request Date

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Alternate Appointment Request Time

Horário

How Would You Like to Complete the Patient Forms? *

Complete in office (arrive 25 minutes before your appointment time)

Email me the forms

Please let us know what conditions you're seeking treatment for. *

Some conditions may not require an in-office visit. If your condition(s) fall into this category, we may decide to do a tele-health visit with you. *

I prefer an in-office visit

I don't know what type of visit I need

Obrigatória

Enviar uma cópia das respostas para o meu e-mail.

Enviar

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