Baptist Health Care
1.888.242.5240 toll-free
850.434.4080 local

or request an appointment online after selecting a physician

Physician Appointment Request

To request a physician appointment, please enter the information and click the "Send Appointment Request" button.

If you prefer to make an appointment by phone, or are unsure of the urgency of your concern, feel free to contact HealthSource, our Physician Referral/Appointment line at (850) 434-4080 or 1-888-242-5240 toll-free.

Privacy Statement: - We believe in protecting your privacy. All information will remain confidential and will not be released to any group outside of Baptist Health Care. Read Baptist Health Care's complete privacy policy

Patient First Name     (legal name)
Patient Middle Initial  
Patient Last Name  
Contact/Parent/Guardian Name  
Street Address  
City / State    
Zip Code  
Email Address  
Patient Gender  
Patient Date of Birth  
Daytime Phone  
Evening Phone  
Personal Physician  
Reason for appointment  
and/or primary concern  
Preferred Physician  
Physician Specialty  
Physician Practice  
Location of Physician's Office  
Primary Medical Insurance  
Secondary Medical Insurance     (if applicable)
Preferred Weekday for Appointment:          
Preferred Time of Day for Appointment:    (9:00 am - noon)  (1:00 pm - 5:00 pm)
How did you hear about Baptist Health Care Physicians?  

Baptist Health Care    1000 West Moreno St.    P.O. Box 17500    Pensacola, Florida 32501-7500    (850) 434-4011

Baptist Health Care is working with Mayo Clinic Care Network to provide the best possible care to patients in our community.