EXISTING PATIENTS:
If you’re an existing patient and would like an appointment, you may call us, or have your doctor call us directly at 585-275-5823.
NEW PATIENTS:
If you’re considering the James P. Wilmot Cancer Center for your care, and you would like additional information, call us at 1-866- 4 WILMOT or 585-275-5830.
Urgent Care
If you’re a new patient with an urgent care need, call us at 585-275-5830.
Non-Urgent Care
If you’re a new patient, and you do not need to speak with someone immediately, then for your convenience, you can use this form to request an appointment. All requests will be processed within 24 hours during regular business hours, Monday – Friday, 8:00 a.m.-5:00 p.m. If we do not contact you by phone to confirm your appointment request, call us at 1-866-4 WILMOT or 585-275-5830.
| Patient Name * | |
| Date of Birth * | (format 00/00/0000) |
| Street Address | |
| City | |
| State | |
| Zip Code | |
| Home Phone * | |
| Work Phone | |
| Contact Me During Business Hours At: Home Work | |
| Social Security # | (format xxx-xx-xxxx) |
| Parent/Spouse Name | |
| Referring Physician Name | |
| What type of cancer have you been diagnosed with? | |
| Type of Insurance | |
| Contract Number | |
| Group Number | |
| Subscriber Name | |