Holy Cross Hospital

Outpatient Scheduling

Thank you for choosing Holy Cross for your outpatient needs. While we work hard to meet all of our patient's scheduling preferences, due to high volumes of appointment requests, selected preferred times are intended to serve only as guidelines.

If you are in need of an appointment within 48 hours (two business days) or if you are having technical difficulties, please contact the scheduling center directly at 954-202-0277. Our hours of operation are Monday through Friday from 8 a.m. to 5 p.m.

If you are over 70 and are having any exam that requires contrast, BUN-Creatinine lab tests must be completed prior to your exam and the results faxed to our scheduling department at 866-397-2465.

Please fill out the outpatient schedule form below:

First Name *

Please enter your first name.

Middle Name

Last Name *

Please enter your last name.

Gender *

Please select your gender.

Date of Birth (mm/dd/yyyy)

Address

City:

State:

Zip Code:

Email *

Please enter email address.

Retype Email Address *

Please retype email address.

Daytime Phone Number *

Please enter valid phone no.

Alternate Phone Number

Type of insurance *

Please enter insurance.

Subscriber Name
(as appears on insurance card) *

Please enter subscriber name.

Policy Number *

Please enter policy number.

Insurance Phone Number *

Please enter insurance phone.

Pre-certification/Authorization Number (if required)

Are you a new patient? *

Are you a new patient.

Name of Ordering Physician

Physician Phone Number

Reason for Procedure *

Please enter reason for procedure.

Procedure *

Please enter procedure.

If "Other", please indicate

Preferred day to contact you to schedule the appointment *

Mon Tue Wed
Thu Fri

Please enter Ordering Physician.

Preferred time to contact *

Please enter time to contact.

List below the test(s) and any
other information including
Diagnosis (Dx) and/or ICD-9 codes
provided on the written order

For online appointment requests, we will attempt to respond within 48 business hours. Please select your dates accordingly.

From :

To :

Time of Day :

Notes :

* = Required Field

If you have additional questions please contact our scheduling center at (954) 202-0277

Outpatient Scheduling

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