You can use these online forms if you are using a Secure Socket Layer (SSL) compatible browser like Internet Explorer, Netscape, Opera, Mozilla, etc. Personal data is encrypted to keep your data private. When you see a lock icon on your status bar, you are viewing a secure web page.

These online forms are only available to current patients of Riverside Medical, S.C.

By agreeing to the terms of our online forms, you will enter a secure area of our site. Riverside Medical, S.C. will not be held responsible in the event your electronic message is not transmitted due to technical problems related to this site or to the hosting server. All personal identifying information is encrypted and your message will not be internally or externally forwarded to other third parties. The information will solely be used by Riverside Medical, S.C.

Your online message will be processed during normal business hours, Monday through Thursday, 8:00 am - 6:00 pm, Friday, 7:30 am - 4:00 pm, and Saturday, 8:00 am - 12:00 pm excluding holidays. Please allow a reasonable amount of time for us to process your online message. If you have not heard from us within two business days, please contact the office by phone.

If you do not accept the terms of this disclaimer, you will not be able to process your online message form online.

Appointment Request  |   Prescription Request  |   Referral Request  |   Message Form