Request an Appointment

Please Complete the Form Below

Note: Note: Any information submitted using this form is transmitted securely and held in strictest confidence, protecting your privacy. A member of our staff will review this information and contact you to schedule.
If this is urgent please call 509-460-5588 to make an appointment.

Appointment Request

"*" indicates required fields

Patient Information

*required

First Name*

Last Name**

Phone*

Email*

Patient's Date of Birth*

Name of Person Making Request:*

What is your Language Preference?*

English

Spanish

Other

Language Preference*

Patient Street Address*

City*

State*

Zip*

Insurance Information

*required

Do you have insurance?*

Yes

Is the Policy Holder the same as the Patient?*

Yes

Policy Holder Name:*

Health Insurance Plan*

Request Appointment

*required

Do You Have A Preferred Provider?*

What is your Preferred Appointment Time?*

Urgency*

How did you hear about us?*

Reason for Visit*

Consent*

I agree to the following:

By checking this box, you acknowledge you are submitting personally identifiable information electronically to TCO for the purpose of providing healthcare. If you prefer to speak with someone please call 509-460-5588 and we can take your information over the phone.

CAPTCHA

CALL US TODAY 509.460.5588

Request an Appointment

Please Complete the Form Below

Appointment Request

Patient Information

Insurance Information

Request Appointment

Trust the Tri-Cities' leading orthopaedic clinic

(509) 460-5588

©2020 Tri-City Orthopaedics. All Rights Reserved.

The Tri-City Americans’ Official Orthopaedic & Physical Therapy Provider

Request Appointment Now!