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Appointment with Dr. Canes

Please enter your information:

*

Phone

*

Are you a new or existing patient?

*

A

Existing patient

B

New patient

Where would you like to be seen?

*

A

Lahey office (Burlington MA)

B

Parkland office (Derry NH)

C

Unsure/Either

If you are not sure, pick the office closer to you. Unsure/Either is fine.

What is this visit mainly about?

*

A

Prostate

B

Kidney

C

Adrenal

D

Bladder

E

Ureter / kidney drainage tube

F

Other

What days generally work best?

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Tuesday

Wednesday

Thursday

Friday

I'm flexible

Health insurance carrier/provider:

*