Schedule, Reschedule, and Cancel Appointments

Name *

First

Last

Phone *

Would you like a text response to this request? (Click YES to opt-in. Upon receiving a text, please respond with STOP to any SMS (text) to opt-out SMS (text) communication; Messaging frequency may vary; Message and data rates may apply.) (see our privacy policy: https://johnnausmdpa.com/privacy-policy/) For assistance text HELP of visit our website at johnnausmdpa.com.

YES
No. Thank you. (please note that we will attempt to CALL you on the above number concerning this request.)

I am a current patient of John Naus MD PA and I would like to: *

Schedule an Appointment
Reschedule an Existing Appointment
Cancel an Exiting Appointment

Would you like to re-schedule an appointment for the future? (This assures that we will send you reminders and keeping up with appointments is essential to maintaining refills of your medications) *

Yes
No

Please put the exact or approximate date and time here. We will cancel it. Put I don't know if you cant remember. *

Would you like to give us some date and time information to expedite the rescheduling process. *

Yes
No. (If you have not seen within 8 months you will be considered a newe patient and need to repeat the new patient process.)

Would you like to be contacted by our office to schedule a follow up appointment? *

Yes. (This will allow you to have an appointment scheduled and you will receive reminders and can always re-schedule in the future.)
No. (Please note that you will not receive appointment reminders without a scheduled appointment and that you will need to be seen in our office to receive regular medication refills.)

Would you prefer an afternoon or morning appointment? *

Afternoon
Morning
Either is fine

Please List a few dates and times you would prefer. This will expedite scheduling.

Preferred Provider? (Feel free to list more than one, but put your first choice first.) *

Date / Time - We are open Mon. - Thursday for appointments. *

Time

Date / Time

Time

Date / Time

Time