Request Appointment | Dr. Michael J.

Request an Appointment

Tell us what's going on. We'll guide the next step.

Location Preference

Nebraska North Platte

Florida Boca Raton

When did this start?

Patient Information

First Name

Last Name

Email Address

Phone Number

Date of Birth

Insurance Provider

Upload Referral / Imaging (Optional)

PDF or Image files max 10MB.

Additional Details

Have you been seen for this before?

Yes No

Pain Severity (1-10)

1 (Mild) 5 10 (Severe)

Impact on Function

Work Sleep Exercise Daily Activities

Additional Notes

Submit Request

Location Preference: TBD

Once you submit your request, Dr. Michael J.'s office will call and email you directly to schedule your appointment time. You do not need to schedule online.

✓

Request Submitted

Name:

Location:

Next Step: We will contact you directly to schedule your appointment time.

What happens next:

✉️ Confirmation email sent immediately.
📞 Our coordinator will call you to schedule your appointment.
📍 Instructions sent 24-48 hours prior to your visit.

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