Request An Appointment

To request an appointment time please fill out the form below.  Please note that we know your time is valuable, and that we will do our very 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
Have You Seen a Neurologist Before *
Preferred Request *
Preferred Request
Secondary Request
Secondary Request
If you have preferred times 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.