Dr. Riegel -- Appointment Request Form

Appointment Request Form

Please fill out the following information and one of our staff members will call you to set your appointment. If you are going to be a new patient to our office, please CLICK HERE to download our New Patient Registration Forms.

Name
Address
City	State	Zip Code
Daytime Phone (Best number to reach you during the business day)
Email
Choose the day of the week that you prefer.
Choose the timeframe that will work best with your schedule.
Between 9:00 am and Noon Between 1:00 pm and 5:00 pm

3108 Midway Rd.
Suite 100
Plano, TX 75093
(972) 608-8979