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Office Locations

  • Maitland office
    846 Lake Howell Rd.
    Maitland, FL 32751
    (407) 767-2477
    (407 834-9822 fax
  • Oviedo office
    1000 W. Broadway
    Suite 100
    Oviedo, FL 32765
    (407) 767-2477
    (407) 767-8478 fax

Appointment Request

This form is only to be used by existing Interlachen patients. New patients wishing to schedule their initial appointment should call the office at 407 767-2477 (Also see link to new patient forms). Additionally, this form should only be used for appointments that are not needed within the next 48 hours. If you need an appointment in the next 1-2 days, please call the office (also see information regarding "Walk-in Hour").

 

Patient Name:
Date of Birth:
Phone:
Email:
Parent Name:
Appointment With Whom:
Preferred Office Location:
Visit Time Restrictions/Preferences
(afternoon, morning, after 3pm, etc.) :
Reason for Visit:
Please list any ongoing medical issues (e.g. asthma, allergies, ADHD, growth or weight concerns, chronic medicines, etc.) so that the appointment may be scheduled appropriately