Results

Request a results review with Dr. Haaland or call back if you missed the call.

Please enable JavaScript in your browser to complete this form.

First & Last Name

First

Last

Email Address

Phone Number

Reason for Contacting

NOTE: Forgot your next appointment date/time? No need to reach out, we will send you an email reminder 2 weeks before your appointment.

for available Address

If applicable, what date was your last appointment with us?

Please provide 3 dates and time you are available for a results phone call.

Calls will go the phone number you've provided. Please ensure you have your phone nearby and volume up so you do not miss the call.

Date / Time You are available for Results call (1 of 3)

Date

Time

Date / Time You are available for Results call (2 of 3)

Date

Time

Date / Time You are available for Results call (3 of 3)

Date

Time

Select when you are available for Weekend Calls

Select all that apply.

Please indicate what times of day you would NOT be available for a call