No walls… just easy access for your patients with gyn surgical needs.

Taking requests 24/7 – created especially for Emergency and Urgent Care providers needing help after hours, but feel free to use it any time you need help with a gyn surgical consultation!

Use this secure, HIPAA compliant form to request appointments for your patients.

  • Most consultations will be scheduled and seen within a few days.
  • Surgical care is a priority for your patients.
  • Most surgeries can be scheduled within 1-2 weeks, or when its convenient for your patient.  Greater priority will be given to patients with urgent needs on a case by case basis.
  • Appointments will be personally scheduled and verified within one business day.
Your Name (Referring Person) *
Your Name (Referring Person)
Referring Phone Number
Referring Phone Number
Patient Name *
Patient Name
Patient DOB *
Patient DOB
Patient Phone Number *
Patient Phone Number