Appointment Request Form

** Before filling out this form, please visit our online appointment scheduler to see if you’re able to book your appointment there. If you’re unable to find a time that works or have additional questions, feel free to complete the form and our team will be happy to assist you. **

Please complete the form to request your appointment. After you submit your form, one of our team members will contact you to confirm your appointment day and time.

Insurance and payment information
Selkirk Diagnostics is a self-pay practice and does not currently accept insurace.  If you would like to submit a claim to your insurance provider, please let us know in the comments section when scheduling your exam and we will provide you with a superbill.  Please note that reimbursement is not guaranteed, as coverage varies by plan. 
We are happy to accept HSA and FSA cards for payment.
Payment is due in full at the time of the exam.