Heart Healthy CT Appointment Request Form

Please complete the form below and we’ll contact you to schedule an appointment.

For Emergencies, call 9-1-1.

Please do not request Heart Healthy CT for acute concerns. Instead, call your primary care physician or our office at 877-860-1141 for guidance if needed.

These requests are checked every business day and a response can be expected within 48 hours. Appointment cancellations should be made 24 hours in advance.

All fields are required.

  • Heart Healthy CT is recommended for men age 40+ and women age 45+, with one or more heart disease risk factor.
  • Address * Required
  • This field is for validation purposes and should be left unchanged.