Page 1 of 2

Appointment with Dr. Canes

Please enter your information:

Are you a new or existing patient?

Are you a new or existing patient?
A
B

Where would you like to be seen?

Where would you like to be seen?
A
B
C

What's the reason for the visit (Dr. Canes does not do vasectomies)?

What days generally work best?

What days generally work best?
A
B
C
D
E

Anything else we need to know?