Appointment Request Form If your request is time-sensitive, do not contact us via email. Please call us at 402-552-2020. Please fill in the form below to setup an appointment.Location* 43rd & Dodge 135th & California 72nd & Giles 181st & Q Council Bluffs Fremont Reason for AppointmentPlease provide a reason for your appointment. Details are stored securely and not sent by email.Preferred Date & Times*Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.Patient Type* New patient Returning patient Please let us know if you are a new or existing patient.Name* First Last Phone*Email* Best Time to be Reached for Confirmation* : Hours Minutes AM PM CommentsEmailThis field is for validation purposes and should be left unchanged.