Online Appointment Request

Establish Patient's request to See Dr. Ahmad.

Name: *

Desired Date and time for Visit *

From

Service Requested *

Visit Type

Primary Insurance Information *

Secondary Phone No.

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Emergency Contact *

Reason for Doctor Visit *

Preffered Pharmacy *

DOB *

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Comprehensive ID Care

Email: *

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Primary Phone No. *

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FOR Establish Patients of SHAHBAZ AHMAD MD to request VISIT:

Gender *

Address *

New Patient's Request for Appointment Online :

ID Card/Driver Lisence

Request an Appointment Online:

Any information submitted using online form is transmitted securely and held in strictest of confidence, protecting your privacy.

Please do not use this form if you have an urgent medical problem or you need to reschedule an existing appointment. Instead, contact our office at (972) 499-5551

After you submit your request, our appointment scheduler will respond within 48 hours. You can also download/fill in new patient forms to save time in the office.

Established patients may click below to request appointment or via patient portal or choose from below. You will get confirmation if time and date is available via email.