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Appointment Request Form

Welcome to Crystal Run Healthcare's online Appointment Request Form.

You can request to schedule a doctor's appointment - For Non-Urgent Medical Visits - from the comfort and convenience of your own computer. If you are currently enrolled in NextMD®, click here to request to schedule an appointment.

Please fill out the following form in its entirety (*=required field). You will have the opportunity to provide us with three dates and times that are convenient for you. When you are finished, please click the Submit button.

Please note that your appointment is NOT scheduled until you have received a confirmation email from Crystal Run Healthcare.

Patient Information
Contact Information
Appointment / Cancel Details


Please choose up to THREE desired appointment dates.

Note: The appointment request form must be sent at least five (5) business days prior to your first preferred appointment date. You will receive confirmation of your appointment via email within two (2) business days. The form is for Non-Urgent Medical Visit requests only.