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Request an Appointment

If you are a new or transfer patient, please inform your existing provider of our dedicated transcript fax number (704) 703-1090. In addition, please enter a note stating that you've already initiated the process in the "Optional Details" field below. Please do not include any personal medical information in the form below.

Full Name(*)
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Preferred Phone(*)
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Email Address(*)
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Preferred Location(*)
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Visit Type(*)
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How did you hear about us?(*)
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Customer Type(*)


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Optional Details
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