Request a Primary Care Appointment
Important: If you are experiencing life-threatening and/or medical emergency, please seek emergency services by calling 911 instead.
Date & Time Primary Care
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Please Provide your Phone Number
Please provide your phone number so that we may reach you about your appointment.
Phone Number
*
Please enter a valid phone number.
Confirm Phone Number
*
Please re-enter your phone number for verification.
Primary Care Plus
Dr. Michael Johnston & Katelynn Falks, CRNP - 7 Windsweep Court - Phenix City, AL 36870
Monday thru Friday 8am-8pm, Saturday 10a-2p
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Primary Care Appointment
Please tell us if you've been to our clinic recently.
Will you need a walk-in/urgent appointment, or a Primary Care visit?
*
Walk-in / Urgent Care
Primary Care
Has the patient been seen by us in the last 7 days?
Yes, for the same reason
Yes, but for different reason
No
Primary Care Plus
Dr. Michael Johnston & Katelynn Falks, CRNP - 7 Windsweep Court - Phenix City, AL 36870
Monday thru Friday 8am-8pm, Saturday 10a-2p
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Reason for the Visit
Please tell us the reason for the urgent visit:
*
Please Select
Cold or Flu Symptoms
Injury
Other Sickness
Annual Physical
Pain
Something Else
Please explain1:
*
Please tell us a reason for the primary care visit:
*
Please Select
Chronic Care Management
Preventative Care
Annual Wellness or Physical
Referral
Something Else
Please explain2:
*
Primary Care Plus
Dr. Michael Johnston & Katelynn Falks, CRNP - 7 Windsweep Court - Phenix City, AL 36870
Monday thru Friday 8am-8pm, Saturday 10a-2p
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Patient Information
Please complete all required fields with the patient's information. Some fields are optional, but may speed up the check-in and appointment process.
Name
*
First Name
Last Name
Email Address
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
 -
Month
 -
Day
Year
Please choose a date
Biological Sex
*
Female
Male
Primary Care Plus
Dr. Michael Johnston & Katelynn Falks, CRNP - 7 Windsweep Court - Phenix City, AL 36870
Monday thru Friday 8am-8pm, Saturday 10a-2p
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Guarantor
Please complete all required fields. Some fields are optional, but may speed up the check-in and appointment process.
Are you the patient, or a parent/legal guardian?
I am the patient
Spouse
I am the parent or other legal guardian
Name
First Name
Last Name
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Care Plus
Dr. Michael Johnston & Katelynn Falks, CRNP - 7 Windsweep Court - Phenix City, AL 36870
Monday thru Friday 8am-8pm, Saturday 10a-2p
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Picture ID and Health Insurance Cards
Please take a picture of both front and back of your picture ID and health insurance cards. Note: these fields are optional, but may speed up the check-in or appointment process.
Picture ID Card (front)
Picture ID Card (back)
Do you wish to apply your health insurance benefits to this visit?
Yes
No
Health Insurance Card (front)
Health Insurance Card (back)
Primary Care Plus
Dr. Michael Johnston & Katelynn Falks, CRNP - 7 Windsweep Court - Phenix City, AL 36870
Monday thru Friday 8am-8pm, Saturday 10a-2p
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Next
Emergency Contact
These fields are optional, but may speed up the check-in and appointment process.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Emergency Contact's Relationship to the Patient
Please Select
Husband/Wife/Spouse
Father
Mother
Grandparent
Uncle or Aunt
Other
Please specify the relationship to the patient
*
Primary Care Plus
Dr. Michael Johnston & Katelynn Falks, CRNP - 7 Windsweep Court - Phenix City, AL 36870
Monday thru Friday 8am-8pm, Saturday 10a-2p
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Agreements
Please be sure to scroll to the bottom of each text box agreement in order to enable the checkbox. Then, agree to the terms by checking the box next to each item.
Primary Care Plus Terms and Conditions
Our HIPAA Policies and Practices
Medical Malpractice Agreement
Primary Care Plus
Dr. Michael Johnston - 7 Windsweep Court - Phenix City, AL 36870
Monday thru Friday 8am-8pm, Saturday 10a-2p
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*Important*
This is the last step. Please read the text below and indicate you fully understand.
Please verify that you are human
*
Primary Care Plus
Dr. Michael Johnston - 7 Windsweep Court - Phenix City, AL 36870
Monday thru Friday 8am-8pm, Saturday 10a-2p
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