Request an Appointment with Dr. Salinas
Complete This Short Form
What type of appointment do you want?
What type of general surgery are you interested in?
Height & Weight
What is your preferred payment option?
Insurance Information
Insurance Card Photo (Front)
Insurance Card Photo (Back)
What is your preferred language?
Contact Information
Last Step: Click "Submit" Below
You will receive a text and email in the next few minutes to confirm we received your submission.
By providing your phone number to Capital Surgeons Group, you hereby acknowledge and agree that we may send text messages to your wireless phone number for various purposes. Please note that message and data rates may apply. Message frequency will vary, and you retain the right to Opt-out by simply replying “STOP.” For a detailed understanding of how we handle your data, please refer to our Privacy Policy and Terms and Conditions.