Request an Appointment

To request an appointment please fill in the information below. Please do not use this form to cancel or make changes to an existing appointment. This form is a request to have a Dermatology Southeast representative call or email to schedule your appointment. Please note that your selections below cannot be guaranteed. If this is an urgent matter please contact our office at (904) 512-1899, if this is an emergency please contact 911.

If you do not receive a response within 48 hours please contact our office directly.

Name*:
DOB*:
Gender*:
Address*:
City:
State:
Zip:
Email:
Confirm Email:
Phone*:
Phone 2:
Comment:

Are you a current patient?       Yes       No

Best time(s) to call?       Morning         Mid-day         Afternoon

Preferred day(s) of the week for an appointment?

Any Day       Mon       Tue       Wed       Thur       Fri

Please select your preferred provider.

What is the nature of your appointment?

Current insurance provider*:

Member ID number:

 


Contact Us

616 State Rd 13
St. Johns, FL 32259
P: 904-512-1899
F: 904-770-7592

Arianne E. Chavez-Frazier, MD

Hours

Monday through
Thursday
8:00 am – 4:30 pm

Friday
8:00 am – 11:30 am

NOTE:
In case of an emergency call 911!