CIH Waiting List
Thank you for your interest in joining our practice. Dr. Wong is not accepting new patients at this time. If you would like to add your name to his waiting list, please complete the form below. Also at this time, if you are on Dr.Wong's waiting list, you will not be able to see another medical practitioner here at CIH.

Due to high demand of his services, we cannot guarantee when his practice will open for new patients.

Please complete and submit a form for each family member you wish to add to our waiting list

Email address *
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Home Address *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Please select (up to) your TOP 3 health concerns *
Required
Insurance Carrier *
Plan
Name on card
Your answer
Member ID #
Your answer
Submit
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