Appointment Request
Tell us a little about what you need — our scheduling team will contact you to find a time.
Name
*
First Name
Last Name
Will you need an interpreter for your visit?
*
No
Portuguese
Spanish
Japanese
Other — please specify
Phone Number
*
Best number to reach you.
Format: (000) 000-0000.
Email
Optional — if you'd like an email confirmation.
Are you a new or existing patient?
*
New patient
Existing patient
Existing patients: anything about your current care moves fastest through the Healow patient portal.
Preferred physician
Please Select
No preference
Dr. John Homa
Dr. Brian Kowal
Dr. Andrew Kramer
Dr. Timothy O'Rourke
Dr. Jose Reyes
"No preference" usually means the soonest available appointment.
Preferred location
Either
Yarmouth Port
North Falmouth
Preferred days & times
e.g., Tuesday or Thursday mornings
Reason for visit
*
Please Select
Prostate / PSA
Kidney stone
Urinary symptoms
Vasectomy consult
Men's health
Second opinion
Other
Anything you'd like us to know
I consent to UACC leaving a detailed voicemail regarding my appointment.
*
Yes
No
Text messages (optional)
I consent to receiving appointment-related text messages from UACC. Msg/data rates may apply. Reply STOP to opt out.
Submit
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