Always There.

Request an Appointment

Complete the form below or call the Physician Referral Service toll-free at 888-362-2500 between 8 a.m. and 5 p.m., Monday through Friday.

A Referral Advisor will call you within two business days to assist you in coordinating a new patient appointment with the DMC Physician you have selected.

Note: The Request an Appointment feature connects patients with physicians through a three-way conference call; the Referral Service does not have direct access to physician schedules. If you prefer you may contact the physician office directly.

Talk to DMC
Step 1
Christina Shanti M.D.
Pediatric Surgery
Step 2
Choose a form

Patient First Name*
Patient Last Name*
Patient Middle Initial
Please enter in month/day/year format - example: 01/01/1970.
Patient Birthdate*
Open the calendar popup.
Parent/Guardian Name
(If applicable)
Requestor’s Name,
if different from patient
Apt Number
Alternate Phone
Best time of day to Call*
Confirm Email*
Insurance Provider*
Plan Number
Policy Holder
Are you a new patient*
Use the calender to select up to 3 dates.  
Timeframe Requested*
Day 1  

Day 2  

Day 3  
Reason for

Additional Information
Regarding this request
Information collected will not be sold, shared or used for future marketing or other communication beyond this request, unless you have consented to receive Email updates from DMC.