Request an Appointment - Colon & Rectal Surgery

Colon and Rectal Surgery Appointments

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Please allow up to one business day for a phone call from our staff after submitting your request.

This form is for new Colon and Rectal Surgery patients only. If you are already a patient, please use MyBILH Chart to request your appointment.

Appointment requests are for non-urgent concerns. If you have an urgent medical concern, call 911.

First Name Last Name Referring Provider Name PCP Name Reason for Request Email Address Phone Number

When is the best time to reach you?

Morning Afternoon