Check-in to DeGraff Medical Park

Appointment Type

Scheduled Time

Friday, March 28 at 4:30 pm

Reason for visit *

Has the patient visited DeGraff Medical Park before? *

Patient's Health Insurance Plan

Patient's Insurance Member Number

Patient's Insurance Group Number

Email Address *

We need your email address to send you the details of your visit. This email also includes cancellation instructions. No spam, we promise.

Patient's First Name * (Legal Name)

Middle Initial

Patient's Last Name *

Date of Birth *

Phone Number *

Gender *

Zip Code*

Contact Name (if different from patient)

Terms and Conditions

Using our secure server

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