Appointment Requests

If you are ill, a new patient or requesting an appointment for today, please call our office directly at (706) 324-7700.
For your convenience, we have created the online appointment request below. We see patient’s from Monday to Friday, 8:30AM to 5:00PM. Please complete the form and click the “Submit” button at the bottom of the page.

Be sure to provide all required information. Once our staff receives the request, we will call you within three business days to schedule your appointment. The Appointment Request is secure; your information will be kept confidential and viewed only by our practice staff and physician.

Required Fields **

Name**
Date of Birth**
Home Phone**
Cell/Work Phone**
Email**
Are you a patient of this practice?**   Yes   No
Reason for your appointment**
Insurance Carrier**
Policy and Group Number:
Primary Care Physician/Referring Doctor**
Scheduling Information: Specify the days and times that work best for you (check all that apply). Monday Tuesday Wednesday Thursday Friday MorningAfternoon MorningAfternoon MorningAfternoon MorningAfternoon MorningAfternoon
How did you hear about us?** NewspaperFriend/FamilyHospital/ER WebsiteYellow PagesPamphlet ScreeningInsurance BookPhysicial Referral ExpoOther
Additional Comments or Notes