REQUEST AN APPOINTMENT
First Name Middle Initial
Last Name
Date of Birth
Email
Daytime Phone with Area Code -
Please choose the doctor you would like to see:
Please choose two appointment dates in order of preference:
First choice:
 
Second choice: 

What time of day would you prefer?  (please check one)
Morning       Afternoon        Either
Which Orthopaedic Specialties location would you like to schedule an appointment for?
Suite C :

Dr. Morris, Dr. Abdo, Dr. Hughes,
Dr. Schuele
1011 Jeffords Street
Clearwater, FL 33756
Phone: 727-446-5993
Fax: 727-446-4477

 Suite D:

Dr. Piazza, Dr. Davidson, Dr. Marcotte
1011 Jeffords Street
Clearwater, FL 33756
Phone: 727-449-2599
Fax: 727-442-8804
Have you ever been a patient with Orthopaedic Specialties before?  yes   no
If so, approximately when: 

Reason for your visit and/or additional information that you wish to provide us.  Please be detailed and specific.
If you will be using insurance coverage for this visit, please indicate your carrier(s):
Primary:   HMO?yes    no
Secondary:   HMO?yes    no
     
If your insurance is an HMO, who is your primary care physician? 
How would you like us to confirm your appointment?
Telephone - preferred and fastest method of confirmation (be sure that you filled in the "phone #" field at the beginning of this form)
E-mail (be sure that you provided an email address at the beginning of this form)
 
Before submitting this appointment request with the button below, please re-read your entries to ensure that your information is accurate and read the following privacy statement.

Orthopaedic Specialties considers the information that you submit through this form strictly confidential and we will never willingly share it with anyone without your permission.  Data submitted through forms on the Internet can be hijacked by hackers.  Please be advised that Orthopaedic Specialties can not guarantee the electronic-transmittal security of the information you submit using this online form.  The only way to ensure your information is completely secure is to speak with our office face-to-face.  Instead of using this form, you can call our office, Monday through Friday, at 727-446-5993.  If you understand the security risks and still choose to transmit this online form data, click the Submit Form button below.