Canyon Medical Center

Patient Forms On-Line Consent Form On-Line Refill Request

| appointments/cancellations | contact us

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Canyon Medical Center Online Appointment/Cancellation Request

To request, cancel and reschedule your appointment
Please complete all of the following fields to ensure that your appointment request is complete.

THIS APPOINTMENT FORM WAS CREATED TO REDUCE THE NUMBER OF INCOMING PHONE CALLS SO THAT WE CAN BETTER SERVE OUR PATIENTS. PLEASE DO NOT CALL TO SEE IF THE EMAIL WENT THROUGH.

We will contact you to confirm the appointment once we have processed the email. For life threatening emergencies please do not use this email form.

Please Note: We ask that you complete this form at least 24 hours in advance should you need to reschedule or cancel your appointment. Failure to do so may result in a $50.00 no show fee.

Scheduling or canceling an appointment online - Our policy is to complete your appointment request within 1 hour of your request during regular business hours. We will contact you and confirm an appointment within the time frames you provided. If there are no appointments available we will offer other times outside your window.
I would like to: Schedule an Appointment Cancel my current appointment Cancel and reschedule my current appointment
Physician name
If your primary care physician is not available you may see one of our Certified Nurse Practitioner
Patient Name
Patients Birth Date	MM/DD/YYYY
E-mail address
Re-enter E-mail address

Date of appointment you are canceling	Time MM/DD/YYYY

Reason for Appointment
First Choice	Between and MM/DD/YYYY
Second Choice	Between and MM/DD/YYYY

Office Hours:
Monday-Friday: 8am to 5pm
We offer appointments during the times listed above.

;Phones open at : 7:30 a.m.

Laboratory Hours:
Monday-Friday: 7am to 4:30pm

List Of Doctors:
J. Kelley Brennan, M.D.
Stephen Canowitz, M.D.
John DiPietra, M.D.
Mark Hackman, M.D.
Robert Hershfield, M.D.
Stephen Shell, M.D.
Ethan Shoaps, M.D.
Catherine Spiess, M.D.
Boris Valdman, M.D.
Timothy Nuss, C.N.P.
Susan Rankin, C.N.P.