FOR AN EMERGENCY, CALL 911

This form may be used to request a routine (i.e. non-urgent) appointment at Clinic 45.

You will be contacted BY PHONE, usually the same day we receive your email, to schedule your appointment.

If your medical need is urgent (but non-emergency), call your physician’s office directly or visit Clinic 45.  

 

OUR SERVICES:

1- WEIGHT MANAGEMENT
2- FAMILY MEDICINE
3- INTERNAL MEDICINE
4- FAMILY PLANNING
5- ANT I- AGING

 
     

 Comments:

Please enter your contact information:

Patient Name:
Parent or Guardian (if patient is a minor):
Patient's Date of Birth:
/ / ( i.e. mm / dd / yyyy )
Preferred time of day to be called:
Phone number where you can be reached:
Your Email Address:
 
 
8221 Gulf Freeway, Suite 400 Houston, TX 77017 Office: 713-847-9400 Fax: 713-847-9405
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