Request An Appointment

You can request any type of appointment you need by using the Request an Appointment form below. Use the selection pull-down to let us know what you need scheduled. Don’t worry if you’re unsure about the type of appointment needed. Select whatever you feel is best and we’ll discuss it with you when we call.

Request an Appointment

Please complete the form below. We will follow up with a phone call to schedule your appointment.

Select Type of Appointment

First Name*

Last Name*

Email*

Phone*

Address*

City*

State*

Zip*

Name of Insurance Company*

Name of Primary Care Provider*

Date of Birth*

Please verify your request*

Your information is protected by HIPAA- (Health Insurance Portability and Accountability Act) compliant patient forms. Your information is secure and protected from unapproved eyes.

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Connecticut GI Non-discrimination policy Connecticut GI, PC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Connecticut GI, PC provides free aids and services to people with disabilities to communicate effectively with us. We provide qualified sign language interpreters and Free qualified language interpretation services to people whose primary language is not English.

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