Request An Appointment

  • If patient is a MINOR (under 18)

  • Medical History

    Do you have any of the following medical conditions?
  • Financial Info & Additional Fees

    Initial below each line to acknowledge that you've read it.
  • Important Reminders

    Initial below each line to acknowledge that you've read it.

  • Requested Appointment Information


Various ways to “request” an appointment

  1. By completing online form ABOVE. The (*) indicates that the field requires an answer.
  2. By phone: 850-877-3183 | Mon-Fri 8:30 AM-4 PM
  3. By email:

Bring PATIENT FORMS to your appointment to reduce the amount of time spent in our office.

The online request is NOT a confirmed and scheduled appointment. We will call you to confirm your appointment as soon as possible. If you requested your appointment Monday-Wednesday (before 4pm) and have not heard from us after 24 hours, please call us after 8:30 AM at (850) 877-3183.

If you are requesting an appointment on Thursday (after 4pm), Saturday, or Sunday we ask that you give us until the following Monday to call to confirm your appointment due to the fact that we will not receive it until we return to the office Monday morning, and if we are seeing patients on Monday we will not call to confirm appointments until the following Tuesday.

We will do our best to  accommodate you. We do appreciate your patience.