CPAM - Request an Appointment

To request an appointment, use the form below. 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

Preferred Houston Methodist location(s). Please check all that apply. *

Texas Medical Center Baytown Clear Lake Cypress Katy/West Houston Sugar Land Willowbrook The Woodlands

May we contact you at the patient's email address above? * Yes No

Additional Information

Artist Registration

We recommend you register as an artist in the Houston Methodist system so you will be identified as an artist. Once registered you will be included in Artist Health and Arts related communications.

I would like to register as an artist at Houston Methodist.

Yes

Additional Information

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

Yes

Authentication *