Request for Appointment

If you have symptoms of an urgent nature, please call your doctor or go to the nearest emergency room immediately.

Request For Appointment

  • Patient Information

  • Referring Physician

  • Primary Care

  • Insurance Information

  • In case of emergency, please contact:

  • With this form, you are submitting a request for an appointment. You are not scheduling an appointment. A representative from the Az Heart Rhythm Center will contact you to help you schedule an appointment.