Request an Appointment


To request an appointment time, please fill out the form below.  We know your time is valuable, and we will do our best to accommodate your request.  

Patient's Name *
Patient's Name
Patient's Date of Birth *
Patient's Date of Birth
Best Phone Number to Reach Parents *
Best Phone Number to Reach Parents
Mother's Full Name
Mother's Full Name
Father's Full Name
Father's Full Name
Include city, state, and zip code
Patient's Primary Care Physician
Patient's Primary Care Physician
Policy Holder Name
Policy Holder Name
Policy Holder Date of Birth
Policy Holder Date of Birth
Have You Seen a Neurologist Before? *
If you have preferred times/days for you appointment, please let us know below.
Dr Riela has been my sons neurologist for over 20yrs. My son has Lennox-gastaut (seizure disorder) and he probably wouldn’t be with me today if not for Dr. Riela and the good Lord!
— Lena T.