Request an Appointment

To request an appointment at the Ridgedale Surgery Center, fill out the form below and click “Send Request.” We will direct your request to the appropriate physician office to contact you for an appointment.

Please note: This request form is not intended as a tool for reporting a medical emergency or medical problem. It will not go to a physician and is only monitored during normal business hours. If you have critical or timely information, please contact a physician directly. If you have a medical emergency, please call 911.

First Name*
Last Name*
Email Address
Phone Number*
Zip Code*
Preferred Location*
Preferred Physician*