Join the Cancellation List
If your preferred date is not available, you can join the cancellation list here. This form does not create an appointment or hold a time. If a cancellation occurs, we will contact people on this list in the order received. You must still book your appointment through the online scheduler.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Preferred Date
*
I understand this is not an appointment. I will still need to schedule an actual appointment through the online scheduler. I understand this form only adds me to the cancellation list and does not guarantee a sooner appointment.
*
I agree
Join List
Should be Empty: