Appointment request

Choose your preferred day.

Tell us when you would like to meet. Our team will contact you to confirm availability and appointment details.

Request a consultation Call (656) 200-7940

Appointment preferences

First name (required)

Last name (required)

Email (required)

Phone

Appointment type (required)

Preferred date (required)

Preferred time (required)

City / County (required)

Additional information

Privacy Notice: Please use this form only to request an appointment and provide general scheduling information. Do not submit medical records, diagnoses, treatment information, wound photos, Social Security numbers, insurance/member IDs, financial information, or other sensitive personal or health information. This form is not intended for the transmission of Protected Health Information (PHI) or emergency medical concerns.

By submitting this request, you confirm that the information provided is limited to general contact and appointment-request information and, if submitting on behalf of another person, that you are authorized to do so. You are responsible for the accuracy and appropriateness of the information you choose to submit. Submission of this form does not establish a patient-provider relationship, guarantee acceptance for services, or confirm an appointment.

Your selected date and time are preferences only. An appointment is not confirmed until Tropical Breeze Health Care contacts you and confirms availability.

For confidential health information or medical records, please call (656) 200-7940 so we can provide an appropriate secure method of communication. For medical emergencies, call 911.

I acknowledge that this form is for appointment-request purposes only and agree not to submit medical records, Protected Health Information (PHI), or other sensitive personal information through this form.