CPAM - Request an Appointment

To request an appointment, please contact 713.394.6088 or complete the form below. If you submit a form, a representative will contact you within 1-2 business days to confirm or discuss your request.

 

*denotes required field

Patient Information

Patient's first name * Patient's middle initial Patient's last name * Patient's address 1 * Apartment/Unit City * State * Postal code * Country Preferred phone * Patient's email address * Date of Birth * Gender Male Female Health insurance plan name Health insurance type EPO HMO Medicaid HMO Medicare POS PPO Other

Is there a specific doctor you are requesting?

Yes No

If Yes, please provide name Patient status with this doctor New Established Specialty preference Reason for appointment

Appointment Preference

Day of the week Any Monday Tuesday Wednesday Thursday Friday Time of day Any Morning Afternoon When First Available One Week Two Weeks Three Weeks May we contact you at the patient's email address above? * Yes No

Additional Information

Artist Card

An Artist Card registers you into the Houston Methodist system so you will be identified as an artist. In addition, the card itself will provide you with important phone numbers for making appointments as an artist.

I would like to receive a complimentary Artist Card

Yes

Additional Information

I would like to stay connected with Houston Methodist on upcoming events, health tips and newsletters.

Yes

Authentication *