To Schedule a Well Appointment

IF THIS IS AN EMERGENCY please call 911 or take your child to the nearest emergency room. If your child is a new patient to our practice, please call us to schedule an appointment by phone.

Our staff will check availability for these appointments during regular weekday hours and make every effort to respond to your request within 48 hours.

Dublin Office:
614.766.6321

Upper Arlington Office:
614.457.6461

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Well Appointments
* Indicates required field

*Select the location for your appointment	Dublin Upper Arlington
*Select the Physician you wish to see:	Dr. Banks Dr. Ricciardo Dr. Hackshaw Dr. Shannon Dr. Ortiz
*Please select preferred month:	Select Month January February March April May June July August September October November December
*Please select preferred day:	Select Day Monday Tuesday Wednesday Thursday Friday
*Please select preferred time:	Select Time Morning Mid Day Afternoon
Please enter a specific time if needed:
*Patient's First Name:
*Patient's Last Name:
*Patient's Phone Number:
*Email Address:
*Patient's Date of Birth:
*Please Select the Reason for Appointment:	Well Visit Meet & Greet Allergy Injections Follow Up Visit Conference ADHD 3mo. Follow Up Other
If you selected "Other" please elaborate: