Request an Appointment with Otolaryngology

Ear, Nose and Throat Appointments for New Patients

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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 Otolaryngology 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.

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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