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Home » Contact Us » Appointment Request Form

Appointment Request Form

If this is an emergency, do not contact us via email, please use our emergency contact information.

We require a 24 hour notice for cancellations or rescheduling.

If an appointment is not cancelled or rescheduled more than 24 hours in advance you will be charged a $45 no-show fee. These fees are not covered by insurance.

To request your next appointment, please complete the form below and let us know the most convenient time and date for you. Please don’t forget to include accurate contact details so we can follow up with you to finalize your request.

  • Please fill in the form below to setup an appointment.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
  • Please let us know when you would prefer to have your appointment. Our hours are listed on our location page.
    Please let us know if you are a new or existing patient.
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  • This field is for validation purposes and should be left unchanged.
  • Save time on your next visit by completing this Patient History form online. Your personal information is safe and secure. We abide by all HIPAA privacy policy guidelines.
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We will be moving in late Spring 2022 to our new office space!

37 Calumet Parkway
Building M, Suite 100
Newnan, GA 30263

We hope to see you there!