Patient Forms

Please print and fill out these forms so we can expedite your first visit:

Methods of Payment

• Cash
• Check
• VISA
• MasterCard

Payment is expected at the time of service unless other arrangements have been made with the office.

*Self pay patients (non-insurance visits) are eligible for discounted services*

Please pay your bills with a check or cash when possible.

APPOINTMENT REQUEST

WE ARE ALWAYS ACCEPTING NEW PATIENTS.

To request an appointment, please fill out the form below. Our scheduling coordinator will contact you to confirm your appointment.

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Our Affiliations

Monticello Community Surgery Center

Augusta Health

Martha Jefferson

APMA

ACFAS

AAPSM

VPMA