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Appointment Request Form

Office Hours
Monday - Friday 8:00am - 5pm

Early appointments are available Monday and Wednesdays starting at 7:15am

Phone (620) 662-6000
Toll Free (877) 662-6001

* = Required Fields

Name: *

Date of Birth (mm/dd/yyyy): / / *

Phone Number: *

Email Address:

Choose your preferred appointment times:

1st Time Preference

Day Choice:  

Time of Day:   AM    PM    No Preference

2nd Time Preference

Day Choice:  

Time of Day:   AM    PM    No Preference

Doctor Preference:

Purpose of Visit:   Left   Right   Both


You should receive a phone call of confirmation within one day. We will do our best to work your preferred time and doctor into our schedule and will let you know the details of your appointment when we call.




the SUMMIT           1818 East 23rd Ave., Hutchinson, KS 67502 | 620-662-6000 (Clinic)| 620-665-7766 (Rehabilitation & Sports Performance)