Appointment Request Dr. Alex Vazquez Appointment RequestPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Appointment Request *New PatientEstablished PatientIf you have seen Dr. Vazquez within the last 3 years, please choose established patient.Patient Name *FirstLastPatient Date of Birth: *Phone Number: (Cell Preferred) *How would you like us to notify you of the scheduled appt? * Text Call E-mail Email *Primary Insurance NameOnly required for new patients or if there has been a chance since your last visit with Dr. VazquezMember ID #Only required for new patients or if there has been a chance since your last visit with Dr. VazquezPatient Home Address: Only required for new patients or if there has been a chance since your last visit with Dr. VazquezPCP or Referring Provider NameOnly required for new patients or if there has been a chance since your last visit with Dr. VazquezReason For Visit *Reason For Visit?Routine Follow-UpSpecialist ReferralHealth ConcernsTest ResultsMedication ReviewChronic Condition ManagementOther scheduled 2. Primary 1. Appointment Location: 3627 University Blvd S. Suite 300, Jacksonville, FL. 32216 Monday Morning @ University Office Monday Afternoon @ University Office Tuesday Morning @ University Office Tuesday Afternoon @ University Office Thursday Morning @ University Office Thursday Afternoon @ University Office Please choose up to 2 days/time that work for your schedule. Morning (9am-12pm) Afternoon (1pm-4pm).2. Appointment Location: 1361 13th Ave. S. Suite 245, Jacksonville Beach FL. 32250 Monday Morning @ Beach Office Monday Afternoon @ Beach Office Wednesday Morning @ Beach Office Wednesday Afternoon @ Beach Office Please choose up to 2 days/time that work for your schedule. Morning (9am-12pm) Afternoon (1pm-4pm).Submit
