Program Selection – 24 Hour Physicians

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(800) 217-7440
careteam@24hourphysicians.com

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Which Service do you need? (Click on Link to Select)

Same Day Appointment ($99)
Next Day Appointment ($69)
Second Day Appointment
60 min Counseling Session ($149)
20 min Counseling Session ($99)

Get in Touch

careteam@24hourphysicians.com
(800) 217-7440
San Simeon Place 2121 W Spring Creek Pkwy, #234, Plano, Texas 75023, US

IF YOU HAVE A MEDICAL OR A BEHAVIORAL HEALTH EMERGENCY, CALL 911.

Seek immediate medical attention if you experience a life-threatening condition or acute or severe symptoms.

Copyright © 2021. 24hour Physicians.http://ww.24hourphysicians.com

Appointment Signup

Request An Appointment – Same Day Physician Consultation

Please complete the entire Request An Appointment form to the right. After we have confirmed payment and reviewed your Appointment Request information we will contact you.

Normal wait time to be contacted is within one hour from submitting the Request An Appointment form.

Cell Phone

This form must be completed before we can schedule your appointment. Please complete all information as accurately as possible to ensure we can best meet your satisfaction.

Please note, we CANNOT prescribe narcotics, or controlled substances.

Patient Information

First Name

Middle Name

Last Name

Email

Patient’s Sex

Date of Birth

Address

Address 2

City

State

Country

Zip code

Select a State for Services:

Preferred call

Medical Information

Pharmacy Phone.

Current Medical Concern

Known Allergies

Height (inches)

Weight (lbs)

Smoker?

Body Temperature (F)

Please list all current medications (Rx, Over the counter, Home remedy):

Date of Last Physical

Any medical history not covered in any of the previous questions?

Do you have Cardiovascular disease?

Primary Physician Name

Primary Physician Phone

I acknowledge that the information above and attached is complete and accurate.

Signature: Type your FULL NAME

Electronic Signature Agreement. By selecting the “I Accept” button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting “I Accept” you consent to be legally bound by this Agreement’s terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide Company instructions via Company’s website or its affiliates, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as “E-Signature”), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and Company. You also represent that you are authorized to enter into this Agreement.