Request An Appointment - Greeg Family Healthcare Clinic

This Online Appointment Request Form is for both New & Existing Patients/Customers of the Greeg Family Healthcare Clinic.

If you have any questions regarding the scheduling of an appointment, please feel free to call our clinic directly at:

(575) 532-5700.

How This Works

If you are a NEW or EXISTING patient(s), you can use this Online Appointment Request form.
Please submit the correct information with filling out the form.
REGARDLESS, WE WILL CALL YOU TO VERIFY THIS REQUEST. Please do not consider your request as processed, until you get a phone call from our clinic staff to confirm.
WE CANNOT PROMISE you will get an appointment on the date and time you request. But submitting your date and time preferences will help us seek as close to a day/time that can best fit your schedule. During our call to you, we will confirm/discuss the actual availability of your appointment.
If you have an urgent request that cannot wait, please feel free to contact us directly via phone at (575) 532-5700.
STEP 1 - Fill out the Request For An Appointment Request form.
STEP 2 - We will receive, process, and call you to confirm your scheduled appointment.
STEP 3 - If you do not hear from us in 48 Hours since you submitted your request, please call our clinic at (575) 532-5700. Please be patient and understanding about our clinic's hours of operations. If you submit your request after we close on Friday, we will not be able to get to your request until sometime Monday morning/afternoon. We operate on a first come first serve basis.
Please note that you also have the option of calling us directly to schedule your appointment at any time. This online option only provides an alternative means of scheduling appointment. We periodically check for submitted online requests throughout the day.
Please be sure to provide us with the correct phone number you could be reached. Please understand that we will only make 4 attempts to call you once we get a chance. Upon our 4th attempt to call you, we will leave a message that we have attempted to contact/call you. We will only hold on to your request for up to 24 hours from our 4th call attempt, and then we will just discard/delete your request. Thereafter, you will either need to schedule your request via phone, or if your request is not for an urgent need...you can re-submit another request online.
WE WILL NOT REPLY TO YOU VIA EMAIL. In compliance with Federal Medical Rules/Laws & Regulations, and as part of our clinic's practice & policies, we will not communicate with you via e-mail. The only email that you can ever get from this system is an e-mail copy of your submitted request online. Please feel free to ask our staff if you have any questions about this on your next visit to our clinic.
- Please NOTE:
  - To properly fill out the form completely with accurate and complete information. It is a requirement for us to contact you to validate the request. We will not just process your request without us first contacting you to confirm your appointment.
  - We will also contact you in the event that we find a problem with your request.
- None of the information that you submit through this website is saved. In compliance with online Medical Regulations, all information is directly delivered to the clinic and then destroyed/deleted. Records of the transaction is noted in the patient's file/record keeping system. Please contact our clinic if you have any questions regarding this online Prescription Refill Request Form.

If you are a human and are seeing this field, please leave it blank.

Fields marked with a * are required

Who is sending this request?

Understand that this form has 2 parts. The first part, is for our medical staff to understand, who it is that is submitting this request. It is important for us to understand who it is that we need to call back, to validate this request. So please provide us with your name, and a telephone number where we can reach you at.

Your First & Last Name * Help Text

At What Phone Number Can We Call You? *

Patient Information

This second part is to understand who the patient is for this request. Please provide the patient's Name, Date Of Birth. Please also let us know for what this appointment will be for: (Example: Vaccination, Check-Up, Follow-Up, Sick/ill, etc...)

Patient Name - First & Last * Help Text

Patien't Date Of Birth * Help Text

Patient Status? * Help Text

Patient Age? *

What day of the week would you like to request? *

Time Of Day? Morning or Afternoon? * Help Text

What is this appointment for? * Help Text

Please include any additional information/details that can better help us process your request.

If you are a mother, and this request is for more than one Child/Patient, please include in the text box below, the "Name" and "Date of Birth" of any of the other patients to include in the processing of this request. As well any needed/helpful notes about each patient to help us - help you. Thank You.

Please Provide Any Additional Information Help Text

"IF" you would like an E-Mail Copy of this request, what is your E-Mail Address

Please note, that only IF you would like to receive an email copy of this request, please include your email address below, so that the system, can email you a copy of this request.