Request an Appointment

Tell us about yourself

Disclaimer: This appointment request form is for non-urgent scheduling inquiries only. If you are experiencing a medical emergency, please call 911 or go to the nearest emergency room immediately. If you are a post-operative patient or require urgent medical attention, please call our office directly instead (724-656-0086) of submitting this form to ensure prompt assistance.

TELL US ABOUT YOURSELF

CHOOSE DATE & TIME

Are you a new patient?

Yes

No

Please select an option.

Has your insurance changed?

Yes

No

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Patient First Name

Please enter your first name.

Patient Last Name

Please enter your last name.

Email

Please enter your email

Phone Number

Please enter your phone number.

I would like to receive text communications from Dr. Neil Singh, such as appointment confirmations, appointment reminders, and feedback requests. Message & Data rates may apply.

Insurance

Please enter insurance.

Date of Birth

Please enter your date of birth (mm/dd/yyyy).

Reason for Request

Please enter the reason for your request.

Disclaimer: This appointment request form is for non-urgent scheduling inquiries only. If you are experiencing a medical emergency, please call 911 or go to the nearest emergency room immediately. If you are a post-operative patient or require urgent medical attention, please call our office directly instead (724-656-0086) of submitting this form to ensure prompt assistance.