New Patient Wait List Please enable JavaScript in your browser to complete this form.Name *Email *Phone number *Please select all that apply to you:BIPOCqueertransdisabledfatother, specify belowI am able to offer a limited number of tier 3-5 appointments so prioritize patients who are marginalized within mainstream healthcareWould you like to also be included on the "standby" list?yesnoThis opts you in to receive emails alerting you of last minute appointment openings. If you have a flexible schedule and would like the option of occasional appointments until a spot opens up for you off the wait list (at which point you'll be able to schedule predictable appointments as needed through the online scheduler.) Participating in the standby list does not impact your position on the regular wait list. Sliding scale tier *Tier 3Tier 4Tier 5Please see www.phillyosteopathic.com/rates for more information on the sliding scaleBrief description of why you're seeking care: *Referred bySubmit