Request an Appointment & Physician Referrals

New Patients:

To schedule an appointment at our office, call us at (315) 464-9360 or request a referral/appointment online using our interactive appointment request form below. Our appointment scheduler will respond to your request within 48 hours. Please do not use the interactive referral/appointment request form if you are requesting an emergent appointment. Instead, contact our office directly at (315) 464-9360.

Please be aware that a referral and/or authorization may be needed prior to receiving an appointment. Our staff will assist you with this process.

Be sure to bring any diagnostic imaging or other test results that may have been ordered or performed by another physician. Once you have made your initial appointment, you will receive login instructions for the Upstate MyChart patient portal and medical history forms to complete electronically. Completing the forms prior to your visit will help speed up the new patient medical history intake process.

Established Patients:

Please sign in to the Upstate MyChart patient portal to request an appointment and update forms. If you have not registered for our secure portal or have not received authorization to begin using the portal, call our office to obtain a registration PIN. You may also utilize the interactive appointment request form below.

Referral/Appointment Request Form

Please do not use this form if you have an urgent medical problem or you need to re-schedule an existing appointment. Instead, contact our office at (315) 464-9360.

*=required

Patient Information

The person who will be seeing the physician.

*Type of Patient : New Existing

*First Name :

*Last Name :

Middle Initial :

*Street Address :

*City :

*State :