Appointment Request

Dermatology Services

To request appointment availability, please fill out the form below or call 260-436-8000. Our scheduling coordinator will contact you to confirm your appointment.

First Name

Last Name

Phone Number

Email Address

Date of Birth

Please select three appointment date and time choices.

1st Choice Appointment Date

2nd Choice Appointment Date

3rd Choice Appointment Date

1st Choice Appointment Time

2nd Choice Appointment Time

3rd Choice Appointment Time

Which office location is this appointment for?

What time of day do you prefer?

Reason For Appointment / Comments

Please do not submit any Protected Health Information (PHI).

Fort Wayne Plastic Surgery & Aesthetics

We are now offering the convenience of self-scheduling on popular services. For appointments, call 260-469-1400 or click on a button below.

Book Aesthetics Services Book Plastics Services

Call us

(260) 436-8000
(888) 567-3376
(260) 434-0929 - Fax

Need directions?

Dermatology Services

Fort Wayne Plastic Surgery & Aesthetics

(260) 436-8000(888) 567-3376(260) 434-0929 - Fax

Carnegie Blvd Office Dupont Office Decatur Office Warsaw Office

(260) 436-8000
(888) 567-3376
(260) 434-0929 - Fax

Carnegie Blvd Office
Dupont Office
Decatur Office
Warsaw Office