Appointment Request

The first step towards your successful weight loss journey is to schedule an appointment.  Please contact our office by phone or complete the appointment request form below.  Our scheduling coordinator will contact you to confirm your appointment.

Please do not use this form to cancel or change an existing appointment.

*Items in bold are required.

Name:

Address:

City:

State/Province:

Zip/Postal:

Email:

Phone:

Are you a current patient?

Yes

No

Best time(s) to call?

Morning

Noon

Afternoon

Evening



Preferred day(s) of the week for an appointment?

Any Day

TUE

THUR

FRI

Preferred time(s) for an appointment?

Any Time

Morning

Afternoon

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

Gary Grinberg, MD

General, Advanced Laparoscopic and
Bariatric Surgery
800 Howe Ave., Suite 300
Sacramento, CA 95825
office: (916) 572-CURE (2873)
fax: (916) 568-5575