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Request Appointment Form
Submitted by
amc-admin
on Mon, 06/01/2015 - 13:44
First Name
*
Last Name
*
Phone
*
Email
Date of Birth
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
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19
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31
Year
Year
1940
1941
1942
1943
1944
1945
1946
1947
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1949
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1957
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1959
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2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
New or Existing Patient
*
New
Existing
Doctor
- None -
Abdul Bhurgri, MD
Alina Merrill, DO
Amy Harrison
Ariana Sandoval
Ashley Issac
Betzabe Adame
Brenda Fowler
Brigette Chelchowski
Caitlin Rogers, MD
Carlos Sandoval
Christin Sogge
Clarisa Medina Poeliniz, PNP
Colleen Finlay
Cynthia Lucio
Daniel Feng Wen, MS, PA-C
Dr. Estela Melgoza
Dr. Meera Ravikumar
Edward Kirsh
Fatima Saaduddin
Faylene Salas
Han Yu Stephanie Liou
Irma Correa
Jacob Rorabaugh
Jennifer Vargas, MD
Joanne Zimmerly, APN, FNP, MSN
Johanna Montoya
Kanika Sood
Karina Cisneros
Kiyomi Kimble
Lorena Barragan, MD
Mahamid Khan
Margie Ortiz
Marissa Munoz
Martha Yáñez
Molly Corn
Norma Westervelt, MD
Ricardo Orozco
Rolando Torres
Shachi Patel
Tamajah Jordan
Virginia Schmidt
Wen-Ho Yang, MD
Yesenia Yepez
Yvette Ramirez
Location
- None -
Alivio Chicago Testing Site
Alivio Dental West Lawn
Alivio Testing Site in Berwyn
Alivio Vaccination Site at Arturo Velasquez Institute
Alivio Vaccination Site at YMCA PAV
Benito Juarez Community Academy
Berwyn
Jose Clemente Orozco Academy of Fine Arts & Sciences
Little Village Lawndale High School Campus
Morgan Street
Walk-In Wellness Center at Berwyn
Western Avenue
Desired Date & Time
Comments
Is the appointment for Covid-19 Testing?
*