Exam

New Patients: Request an Appointment

Please fill out the form below to request an appointment at East Olympia Family Medicine. Once received, we will contact you within 2 business days. This form is for new patient requests only. If you are already a patient at East Olympia Family Medicine you can request an appointment online using MyChart.


Check one: New Patient    Current Providence Medical Group Patient

Reason for Appointment I want to receive email updates about Providence Medical Group
Name of patient Patient's date of birth Patient's telephone number
Email address Patient's insurance
In addition to yourself, would you like to schedule any family members to receive care at our clinic?
Yes No
Desired Provider
No Preference - First Available
Marina Berndt, MD
Emily Clay, MD
Ryan Johnson, DO
Paul Knouff, MD
Diana Schofield, ARNP
This form will be encrypted to protect your confidentiality.
This form is for new patients only. If you are already a patient at East Olympia Family Medicine you can request an appointment online using MyChart. If you do not have a MyChart account please call us at (360) 486-6777.