Enter Patient Information
Desired Time Slot
*
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
8:30pm
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00pm
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
8:30pm
First Name
*
Last Name
*
Date of Birth
*
Gender
Male
Female
Select reason for visit:
Covid Testing
Covid Vaccine
DUI
Follow Up Psych
Initial Psych Evaluation
Medical Issue (Asthma)
Medical Issue (Cough)
Medical Issue (earache)
Medical Issue (fever)
Medical Issue (Headache)
Medical Issue (Other)
Medical Issue (Rashes/Burning)
Medical Issue (Toothache)
Medication Assisted Treatment
Mental Health
Substance Abuse Outpatient
Therapy Session
Is this your first visit to Tuerk House?
Yes
No
Enter type of insurance:
Cell Phone Number
Text message confirmation will be sent.
Reserve Time