New Patient Form
Please print form, fill it out, and bring to your first appointment.
2112-A Danville Road
Decatur, AL firstname.lastname@example.org
Phone: (256) 353-8696
Fax: (256) 353-7388
Monday & Wednesday
12:00 PM - 7:00 PM
Tuesday, Thursday, & Friday
7:30 AM - 2:30 PM
To make an appointment by phone - just call (256) 353-8696
To request an appointment online - start here, it's fast and easy!
If this is an emergency, please call the number above.
Please do not use this form for any purpose other than to request an appointment.