Request An Appointment

Revive MD

We're a digitally streamlined practice—reach us via secure message or online booking

Current Patients

Existing patients can log into our secure patient portal to communicate with your provider, manage your appointment, access your test results, view your medications and request refills.

Access Patient Portal (opens in a new tab)

Choose a Provider

First Available

Kishore Lakshman, MD, MPH

Swetha Nataraj, MD

Patient Details

Patient First Name

Patient Last Name

Phone

Date of Birth

Insurance Carrier

Reason For Request

Additional Details

Address:

Please complete this field.

Insurance Policy #:

Please complete this field.

Select an option...

Private Pay

Insurance Pay

Please select an option.

Select Referral Source

Search(Google, Bing, etc)

Social Media

Referral

Word of Mouth

Friends / Family

Online Advertisement

Television

Radio

Other

I accept the Privacy Policy and Terms of Use.

I would like to receive text communications from Revive MD via Treatspace, such as appointment confirmations, appointment reminders, and feedback requests. Message & Data rates may apply.

If you have an emergency, Call 911

You Appointment Request Has Been Received!

Thank you for scheduling an appointment!

At Revive MD, we understand that timely access to care can be just as important as the care itself. That’s why we offer a Private Pay option for new patient consultations—designed for those who want to be seen quickly and conveniently, without the delays that often come with insurance processing.

Learn More

Your Request Summary

Requested Time(s)

Experiencing Issues With This Form? Contact Support

Thank you for subscribing!

You will receive important news and updates from our practice directly to your inbox.

Thanks!