Dr. Akhtar Request For An Appointment
Please fill out the form below and one of our friendly staff will contact you. If this is an urgent matter, please directly call our office at, 602-932-5660.
First Name | Initial of Last Name
*
First Name
Initial of Last Name
Phone Number
*
Have you previously been seen in our office?
Yes
No
Reason For Appointment:
Please Select
Colon cancer
Rectal Cancer
Diverticulosis and Diverticulitis
Crohn's Disease
Ulcerative Colitis
Colostomy and Ileostomy Dysfunction/Repair
Anal Condition
Rectal Condition
Hemorrhoids
Fecal Incontinence
Screening & Diagnostic Colonoscopy
Submit Form
Should be Empty: