Request an Appointment

To request an appointment, enter your information and hit Submit. If you prefer to make an appointment by phone, just call (214) 827-3610 and select option 3.

Provider preference for your appointment

Patient First Name*

MI*

Last Name*

Email Address

Date of Birth (mm/dd/yy)

Postal Address

City

State

Zip

Country

Primary Phone*

Alternate Phone

Best time to call

Preferred week day for appointment

Reason for Appointment and/or Primary Complaint

Is there a physician you would like our Texas Neurology Physician to correspond with after your appointment? (name, address, phone number)

Enter any general comments in the space provided

For security reasons,

type in the code below: