Contact — Modern Endocrine | A Top Endocrinology Provider in Oklahoma

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1616 S Kelly Ave
Edmond, OK 73013

Phone: 405.286.1571
Fax: 405.286.1572

Clinic hours:

Monday, Wednesday, and Friday: 8AM - 4PM (Closed for Lunch 12PM-1PM)
Tuesday and Thursday: 7AM - 4PM (Closed for Lunch 12PM-1PM)

Lab hours

Monday - Friday: 8AM - 4PM (Closed for Lunch 12PM-1PM)

Phone hours

Monday - Thursday: 8AM - 4PM (Closed for Lunch 12PM-1PM)

Friday: 8AM - 3PM (Closed for Lunch 12PM-1PM)

Name

First Name

Last Name

Phone

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Email

What's Your Date of Birth?

MM

DD

YYYY

Message

The following questions are for new patients only

Have you ever been diagnosed by another provider with an endocrinology disorder?

Diabetes (Type 1 or Type 2), Hypothyroidism, Hyperthyroidism, Hashimotos, Thyroid Nodules, Thyroid Cancer, Graves, Pituitary Adenoma, Adrenal Nodule, PCOS, Adrenal Insufficiency, Cushings Disease, Acromegaly, Hyperprolactinemia, Hyperparathyroidism, Osteoporosis, Hypogonadism (males), Low estradiol and/or testosterone (females), Prediabetes or Insulin Resistance

If yes, who was the last provider who treated you for this or who would have the most beneficial records of your medical history for this diagnosis and what is their telephone number? If none please type "N/A".

If no, what is your main concern or reason for this appointment?

If no, Who would have the most beneficial records for your medical history and/or any recent lab testing (within the past year)? If none, please put "N/A"

Sex

Who's Your Insurance Carrier?

Please note, this form should not be used for sending medical information. If you are experiencing a medical emergency, call 911 or go to your nearest emergency room. Your information will be sent to our administrative staff during standard office hours, and then forwarded to your provider. We strive to return calls or messages as quickly as possible, but please allow up to 48 hours for a response to your message. Please include your date of birth, provider, and the best number to contact you.

Contact us

Helping Our Patients Balance Hormones and Lifestyle