Request an Appointment

Please complete the appointment request form below. Our office staff will contact you to confirm your appointment.

Patient Information

Patient Name:
Patient Date of Birth:
New or Existing Patient?	New Patient Existing Patient
Home Phone:
Cell Phone:
Preferred Contact Method:	Home Phone Cell Phone
Email Address:
Insurance:

Appointment Information

Appointment Type:	WellSickTelemedicine
Preferred Provider:	Dr. Sarah Phillips, DNP, APRN
Preferred Location:	1045 S 320th Street #7, Federal Way, WA
Preferred Day:	Monday Tuesday Wednesday Thursday Friday
Preferred Time:	Morning (AM) Afternoon (PM)
Secondary Preferred Day:	Monday Tuesday Wednesday Thursday Friday
Secondary Preferred Time:	Morning (AM) Afternoon (PM)
Question/Comment:

Related Information

• Request an Appointment
• Bill Payment