Request an Appointment

Request an Appointment
For which practice would you like to request an appointment?*
Appointment requests are only available for these practices. Please call other medical practices to request an appointment.
Please call (828) 737-7711 for Baker Center Same-Day Clinic. Online requests are NOT for same-day appointments.
Please call (828) 386-2746 for AppInternal Medicine Same-Day Clinic. Online requests are NOT for same-day appointments.
At which locations would you be open to scheduling your appointment? (Check ALL that apply)*

BooneJefferson/West JeffersonLinvilleBlowing Rock
Patient Name*

First NameLast Name
Patient Date of Birth*

MonthDayYear
Is the patient under the age of 18?

YesNo
Parent or Guardian Name

First NameLast Name
Primary Phone*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I prefer to be contacted by*

PhoneEmail
Which provider referred you to this practice? (optional)
Reason for appointment (optional)
Are you a new patient to this practice?*

YesNo
Should be Empty: