Request Appointment - Alliance Orthopedics

I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form. Please be aware this is an appointment request- In order to confirm an appointment, a patient advocate will reach out to you to gather your insurance information to verify your coverage and go over your benefits one-on-one. A doctor’s referral is not necessary to see our team for a consultation or to receive treatment. We accept out of network payments from the commercial carriers including but not limited to Aetna, BCBS/Anthem, Cigna, Magnacare, GHI/Emblem, Horizon, Amerihealth, United Healthcare, Meritain, Medicare, but we do not accept Medicaid.*

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