Contact Questions about a past referral? Not sure if AMPT is appropriate for a specific diagnosis? We are happy to help you and your office staff get the information they need! Phone: 510.256.5811 Fax: 510.339.0647 Hours Mon ‑ Thu: 7am ‑ 5pm Fri: 7am ‑ 2pm Montclair Village Office 6116 Medau Pl Oakland, CA 94611 Dimond District Office 3530 Fruitvale Ave Oakland, CA 94602 Practice Name:* Phone:*Fax:*Practice Address: Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code List of Providers: Provider Specialties: Office Contact: Direct Line or Email PhoneThis field is for validation purposes and should be left unchanged. FEEL BETTER TODAY! Request An Appointment Appointment Request Please fill out this form and we will contact you within 48 hours. Name (as appears on insurance card)* First Last Contact Phone NumberContact Email Date of Birth MM slash DD slash YYYY Current ClientCurrent Client? Yes NoYesNoPreferred Time of DayMorningLunch Hour - MiddayAfternoonPreferred Day of WeekMondayTuesdayWednesdayThursdayFridayPreferred LocationTelehealth VisitMontclair Village - 6116 Medau Place, Oakland, CA 94611Dimond District: 3530 Fruitvale Ave Oakland, CA 94602Primary Insurance Carrier Primary Insurance Carrier Member ID # Secondary Insurance Carrier Secondary Insurance Carrier Member ID # Notes or SpecificationsCAPTCHAEmailThis field is for validation purposes and should be left unchanged.