Language
English (US)
Spanish (Latin America)
Request an Appointment to Apply for Circle Care Center's PrEP Grant Program
Use the form below to request an appointment at Circle Care Center. Please note that all appointment requests will be confirmed by our staff within 1-2 business days. If you need a same-day or next-day appointment, please give us a call at 203-852-9525. **If you are experiencing a medical emergency please call 911.**
Name
*
First Name
Middle Name
Last Name
Legal Name (If different from above)
First Name
Middle Name
Last Name
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Are you currently a patient at Circle Care Center?
*
Yes, I am a current patient.
No, I am a new patient.
No, I am a returning patient.
Which of our providers are you requesting an appointment with?
Dr. David S. Rubin, MD, FACP, AAHIVS
Dr. Trish Garton, DNP, AAHIVS
No Preference
What is the reason for your visit?
*
PrEP Grant Program 2023
Other
What days/times work best for you?
Please note that our clinical hours are Monday 9am - 7pm, Tuesday - Thursday, 9am - 5pm, Friday, 9am - 4pm.
Submit
Should be Empty: