Non Urgent Medical Appointment

Disclaimer
The staff of All Care Medical will make every reasonable effort to comply with your request. In addition we will make every reasonable effort to respond to your request within 48 hours. However, in certain instances due to factors beyond our control, replies to requests may be delayed.

Patient Name:

Patient Date of Birth:

Patient Age:

Person Calling
(and relationship to patient):

Email Address:

Telephone Number:

Preferred Callback Time (morning or afternoon):

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Are you a new or established patient ?

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Description of problem:

Duration of Problem:

Preferred Appointment date/time (if available):

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* Required Field

Preferred Provider:

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Established Patient New Patient Dr. Korbey Dr. Feldmann Dr. Liu Dr. Ober Jennifer LeRoyer, PA-C

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•	Cigna (except through Tufts plans)
•	Fallon HMO
•	Healthy Kids Gold
•	Mass Health
•	Medicare
•	Network Health
•	NH Medicade
•	United Health Care (except through Harvard Plans)

All Care Medical accepts most insurances. We currently
DO NOT ACCEPT: