Appointment Request for Current Members This appointment form is for use of patients currently enrolled in Dr. Bunch's concierge medical care practice. If you are a new patient, please use this form instead to request your initial meeting. Please do not use this form to contact me for a medical emergency! Please dial 9-1-1 right away. Otherwise, kindly fill in the form below and we will respond to your appointment request promptly. Do not include personal or medical information on this form. Full Name*Email Address* Telephone Number*Cellphone Number*Dr. Bunch's office is open Monday to Thursday, from 8:30am to 4:30pm. Face-to-face appointments are 9:00, 10:00 or 11:00am.Please describe the nature of your appointment or your chief medical concern.If this is an emergency, please dial 9-1-1.How do you want us to respond to you?*Please email me.Please call me on my landline.Please contact me on my cellphone.Sorry for the extra step here. We just want to be sure you're a real live person and not a robot.Please type on the box the characters shown in green below:PhoneThis field is for validation purposes and should be left unchanged.