Sutter Health

Sutter Medical Foundation Appointment Request

NEW PATIENT? Use this form to request an appointment with: Dylan Hickey

ALREADY A PATIENT OF THIS DOCTOR? You can directly schedule your appointment by logging in to My Health Online
http://myhealthonline.sutterhealth.org

You will be contacted within 2 business days about available appointments and to gather any additional information needed before your visit to the doctor’s office. If your need is urgent, please call the doctor's office directly. This form cannot be used for same-day or next-day appointments. If this is an emergency, call 911.

Please have your health plan information ready - it is required so we can quickly confirm your appointment.

*(required) Indicates a required field.

Please choose an office

Demographics

Health plan information

The information below is located on your health insurance card. It will be used to ensure the doctor accepts your payment type.We cannot schedule your appointment without accurate health plan information.
NOTE: If you have an HMO plan, and are already assigned to another physician, you will need to contact your health plan to request reassignment to this doctor.

Appointment preferences

Please give a brief reason for seeing the doctor such as physical exam, knee pain, allergy, etc.

Do NOT use this form for urgent conditions such as shortness of breath, chest pain or allergic reaction. Call the doctor's office directly or if you feel your condition may be life threatening, call 911.

Appointment Preferences:*(required)
Mon Tues Wed Thur Fri
AM
PM

This form cannot be used for same day or next day appointments. Please call the doctor’s office instead.

You will be contacted within 2 business days about available appointments and to gather any additional information needed before your visit to the doctor's office.