NEW PATIENTS ONLY
This form is for new patients who have not been seen in our office.
Current patients: please call or text 618-624-0800.
IMPORTANT
New Patient Form Policy
This online form is intended for NEW PATIENTS ONLY who have not been seen in our office.
Current patients: please call or text 618-624-0800.
Requests submitted by current patients through this form may not be answered in a timely manner.
Please ensure all fields on the form are completed so our team can respond efficiently.
✅ New patients: use this form
📞 Current patients: call/text 618-624-0800
⏱ Missing information may delay response
*If you are a new patient and would like to schedule an appointment, Please fill out the form below.
We strive to remain on time for the benefit of all patients, so we ask that you arrive at least a few minutes before your scheduled appointment. If you are a new patient, please arrive 10 minutes early to complete the necessary paperwork and to allow us time to verify your insurance information.
If you arrive late, we will do our best to work you back into the schedule. However, in our effort to keep other patient appointments on time, your wait may be longer. When possible, please let us know if you will be late to your appointment.
