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Online Appointment Request – Nutrition Service and Diabetes Education

Online Appointment Request – Nutrition Service and Diabetes Education

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Online Appointment Request – Nutrition Service and Diabetes Education
Thank you for requesting an appointment for Nutrition Service and Diabetes Education with Susan Dade, RD, LD, CDCES.

Note: New patients need a referral before an appointment can be scheduled.

Please complete the fields below and submit. Your request will go to a scheduler who will contact you by email or phone within one business day during regular business hours, Monday to Friday.

Please note: this appointment request is not for emergencies, same day or next day appointments. If you need an appointment within the next 48 hours, please contact us directly at our office in Artesia (575.746.3119).

OAR - Nutrition Services and Diabetes Education

YOUR INFORMATION

First Name *

Last Name *

Address *

City *

State *

Zip *

Phone *

Email *

Preferred Contact Method *

Date of Birth *
MM/DD/YYYY

Insurance *

Are you a new or existing patient? *

New patient

Existing patient

NOTE: If you are a new patient, you must have a referral before we can schedule you for an appointment. If you do not have a referral, we ask that you contact your primary care provider's office to send us a referral. If you have any questions please contact the clinic at 575.746.3119. Thank you!

What is the reason for your visit? *
What is the reason for your visit?

Choose your preferred location

Artesia

Carlsbad

No preferenceNo preference

YOUR APPOINTMENT PREFERENCES

Which time(s) of the day would you prefer your appointment? (Check all that apply.) *

Morning (8:00 to 12:00 p.m.)

Afternoon (1:00 to 4:00 p.m.)

Which day(s) of the week would you prefer your appointment? (Check all that apply.) *

Monday

Tuesday

Wednesday

Thursday

Friday

Please provide any additional details about your request, including referral information.

Consent Form *

I acknowledge that this appointment request form requires me to provide protected health information (PHI), which will be used to schedule an appointment at Artesia General Hospital. By submitting this form, I consent to this information being disclosed to the scheduling office, as well as receiving notifications via my requested communication method for scheduling purposes. If email is my preferred method, I understand I may receive unencrypted emails from a scheduler that may contain PHI, such as my name and the type of appointment I have requested.

If you are human, leave this field blank.

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Physicians & Providers

Susan Dade, RD, LD, CDCES

Diabetes Educator

Locations & Hours

Monday – Friday
8 am – 4 pm

Artesia
702 N. 13th St.
Artesia, NM 88210
575.746.3119

Carlsbad Multi-Specialty Clinic
1410 N. 8th St., Suite B
Carlsbad, NM 88220

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