Appointment Requests - Rocky Mountain Infectious Disease Specialists

1450 East A Street, Casper, WY 82601 | Mon-Fri: 8AM-4:30PM / Sat-Sun: By Appointment

PAY ONLINE Request Appointment

Step 1 of 3 - Referring Provider

Referral*
- Self Referral
- Referring Provider

Requesting Provider Name
First Last
Email
Enter Email Confirm Email
Phone*
Fax
Clinic Name
Clinic Address
Street Address Address Line 2 City State ZIP Code
Provider Documents
Max. file size: 50 MB.

SET AN APPOINTMENT