Please allow our office 24 business hours to contact you. This is not a guaranteed appointment. Thank you. First Name* Last Name* Email* Phone*Reason for Visit*Well Women AnnualTransfer of CarePregnancy CareConsultationPROVIDING YOU THE PERSONALIZED, COMPREHENSIVE PREGNANCY CARE YOU DESERVE. Delivery privileges at REX Hospital.Preferred Day of The Week* Monday Tuesday Wednesday Thursday Friday When would you like an appointment?* 1st Available 2 Weeks Out 3 Weeks Out Disclaimer: By checking the box, you are acknowledging that this is not a HIPAA compliant form and any information shared is not 100% secure.* I understand CAPTCHACommentsThis field is for validation purposes and should be left unchanged.