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Please complete the form below to schedule an appointment. We’ll make our best attempt at matching your request and contacting you as soon as possible to schedule your appointment. *If you’re a member of our contracted insurance plans, we’ll also check your insurance eligibility to prevent a delay or interruption of services.

Please note email is not a completely secure form of communication. By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By checking the box "Yes, I want to submit this form" you agree to hold Dr. Dana Girard and her associates harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

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