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secure online appointment requests

Specialist - Future Appointment Request Form - For New and Established Patients

For Emergencies call 9-1-1. For urgent care, after hours or all-night nurses call 512-346-6611.

Austin Regional Clinic is excited to announce that in the next few weeks our “Make an Appointment” Page will relaunch with enhanced new and improved functionality making scheduling appointments for you and your family quicker and easier than before. It’s part of our goal to make your access to coordinated health care easier and simpler.

New improvements you can expect include:

  • One form for all appointments – Regardless of what your appointment need may be, there will be one single form type to request an appointment online. As always, dial 911 in cases of emergencies.
  • Response Time Notifications – A notification of response times will be available at time your appointment is requested.

Please use one request form per patient and appointment.

01/05/15: Due to an increase in Online Appointment requests, please expect a response to your future appointment request within 4-5 business days. We will continue to respond to your same-day requests within 2 to 4 hours on regular business days. If you need a response before that time, please call your doctor's office directly.

Future specialty appointments include initial consultations, follow-up visits and other reasons your family medicine doctor referred you for specialty care.

Fields with * are required.
   
*Patient Last Name
*Patient First Name
Patient Middle Name
*Date of Birth
Parent/Guardian Name N/A if age 18 or older
*E-mail address
(Please enter email address to receive your appointment confirmation)
*Confirm E-mail address
*Preferred Contact Phone ()    -   Ext. 
*Secondary Contact Phone ()    -   Ext. 
*Specialty
*Schedule Appt. with
Doctors
  Click here to see the Provider's Schedule
*Clinic Location
Maps
*Who is your Primary Care Physician?
*Reason for Appt.
*Please specify if Other or Follow-Up visit
*Diagnosis/Symptoms(Medical Concern) if Consult
*Date of onset or duration of current problem if Consult
*Who is your Referring Physician?
*Insurance Plan
Please Let us know your scheduling preference during the week
(you may check more than one)*

If you would like to request a specific date, time, or time frame (i.e. in two weeks), please specify in the comments field below.

Would you like an e-mail appointment confirmation sent to your mobile phone?
Please select No if you do not want to receive a mobile confirmation.
This service is currently provided only for the mobile carriers listed in the drop-down list below.
Mobile Phone # (including area code)  ()    - 
Mobile Phone Carrier:  

Change of Address and/or Phone. Please fill in the following information if you check this box.
*Street Address:
*City:
*State:
*Zip:
*Primary Phone: ()    -   Ext. 
  Secondary Phone: ()    -   Ext. 
Additional Comments or Insurance Changes (500 characters maximum):

This is a secure site.  All personal information is encrypted. Please be sure to include a daytime phone where you can be contacted if there are any questions regarding your request. Please remember to bring your insurance card to the appointment.

Browser Support
For best viewing of Austin Regional Clinic online appointment request forms, users are encouraged to upgrade to the latest version of
Firefox http://www.mozilla.com/en-US/firefox/ or
Microsoft http://www.microsoft.com/windows/ie/download/default.asp Web browser software available for their computer.
For problems using these forms after upgrading, please call our customer service line at 512-272-4636.

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