Online Appointment Request

If you are an established patient with Raleigh Medical Group and would like to schedule a future appointment, please provide the following information. You will be contacted at the phone number provided within 48 hours. If you need an urgent or sick appointment, please call our office at 919-782-1806.

Personal Information:

First Name:

Middle Name:

Last Name:

Phone Number (with area code) :

Your email:

Date of Birth:

Appointment Information:

Your Primary Raleigh Medical Group Physician:

Preferred Month:

Preferred Day(s) of the Week:

Preferred Time of Day:

Reason for Appointment:

I understand that completion of this form is only a request and that if my request is accepted, I will receive a phone call within 48 hours in responce to my request. I also understand that if I do not receive a reply, I can call Raleigh Medical Group Scheduling Department at 919-782-1806 and request an appointment.