Request Appointment | Bayside Orthopaedic, Sports Medicine and Rehabilitation Center

If you have urgent medical needs, please call us at 1.800.432.6637 or 251.928.2401.
When using this form to request an appointment, please allow 24 hours for us to respond to your request. If you do not receive a response within that time, please call us at 1.800.432.6637 or 251.928.2401.
This communication device should not be used for to ask specific or personal medical questions or to transmit personal medical information as this site may not be secure. Bayside Orthopaedic will not answer requests for medical advice submitted through this form.
Please note that not all doctors are available at all locations.

First Name: *

Last Name: *

Date of Birth: *

E-mail: *

Daytime Phone: *

Other Phone:

Do you prefer that we respond by phone or email?: *

New Patient: *

I am a new patient.

I have seen a Bayside physician before.

Requested Time: *

8:00 AM-11:00 AM

11:00 AM-2:00 PM

2:00 PM-5:00 PM

Please select the time of day you would like for your appointment. You may select an alternate time below, in case your requested time is unavailable. Our office staff will take your requested times into consideration and contact you regarding the times that are actually available.

Requested Date: *

Please select your preferred appointment date (Monday-Friday).

Alternate Time: *

8:00 AM-11:00 AM

11:00 AM-2:00 PM

2:00 PM-5:00 PM

Please select an alternate time for your appointment, in case your requested time is unavailable.

Alternate Date: *

Please select an alternate appointment date (Monday-Friday).

Preferred Doctor / Physical Therapist: *

Preferred Location for This Appointment: *

Comments: