We are happy to book an appointment for you. This is not an automatic process. Once we receive you request, we will contact you to confirm a date and time that is as close to your request as possible. This form should only be used for requesting appointments that will take place at least 2 full business days after the time of the submission of this form. If you have an emergency, please call our practice directly at: 336-786-9444 Or after hours call: 276-236-1315. If your appointment has not been confirmed within 48 hours, please feel free to contact the practice by phone to confirm.