Please complete the form below to request an appointment at Alliance Hospital. After you submit the form, a representative will contact you within 72 hours to review your medical information before an appointment may be offered.

Please note: This form cannot be used for medical emergency or scheduling same-day appointment. If you plan to visit us within 24 hours or have a medical emergency, please call (234) 08097142623 Front Desk, (234) 8030944858 Client Service Office