Appointment Inquiry Form Name(Required) First Last Phone(Required)Email(Required) Desired Date MM slash DD slash YYYY Desired Time Hours : Minutes AM PM AM/PM I am interested in(Required) MessageCAPTCHAThis form is not intended for use with personal or private health information, however, e-mail sent via the “Appointment” form is sent to a facility employee on a secure e-mail server. This form is for new patients inquiring about our facility and services. If you are a current patient, please call us at 972-256-3700.(Required) I understand Δ