ADA Inquiry Make an Appointment Ask a Question Find a Doctor Please complete this form if you require additional assistance. This form is NOT intended for medical emergencies or to be used as a way to communicate with care providers. Response time to inquires can take up to 72 businesses hours. Non-disability inquires will not be responded to. Call 911 or go to your nearest emergency room for any urgent medical concerns. Name: Preferred Communication: Phone Email Email: Phone: Questions and Accomodation Requests: