Wait-List Request Form

If you are ready to set a time for an appointment and haven’t already done so, please check our Scheduling App to pick a convenient time and provide all the necessary information.

However, if you were unable to find a suitable time, feel free to complete and submit the form below. In the event that we have a cancellation and an appointment time does become available, we will contact you to offer an appointment time. Unfortunately, we are not able to accommodate same day appointments.

Please note that you will NOT be contacted unless/until the time you’ve requested becomes available.