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Advanced Orthopaedic Specialists

 

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Contact Us

Advanced Orthopaedic Specialists
A Department of Lakes Region General Hospital
14 Maple St., Suite 100
Gilford, NH 03249
Ph: (603) 528-9100
Fax: (603) 524-5743

Request an Appointment

To request an appointment on-line, please complete the form below. An Advanced Orthopaedic Specialists patient service representative will contact you within 48 hours.

* Required fields

*Patient Name:

*Patient DOB:

Patient Account #:

Contact Person
(if other than the patient):

*Patient/Contact Phone #:

Best time to reach you:

Are you a:
New Patient: Current Patient w/Same Problem:  Current Patient w/ New Problem: 

What office location would you prefer:
Office Locations:      Gilford Franklin   Meredith  

Do you have a Provider or Subspecialty Preference:
Provider Requested:     or Specialty Requested:  

Do you have a Preferred Day(s) of Week for your Appointment:
Monday   Tuesday   Wednesday   Thursday   Friday  

Do you have a Preferred Time Of Day:
Morning   Afternoon  

Please describe Problem or Diagnosis - tell us your symptoms, diagnosis, duration of problem, and any treatment to date including diagnostic studies:

How soon would you like to be seen:
this week 1-2 weeks within a month next available

Catpcha Question:


The request an appointment online is provided as a courtesy, and although we endeavor to protect your personal information, Advanced Orthopaedic Specialists cannot warrant the security of any information you transmit to us through online applications, and you do so at your own risk. Depending on the nature of the inquiry, your communication could be discarded or archived. If you wish, you can contact us instead by telephone at the numbers provided throughout this website.

Advanced Orthopaedic Specialists is not responsible if unauthorized parties gain access to the confidential information shared in the online forms.

To protect your privacy, please do not use online forms to communicate information that you consider confidential.