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Patient Appointment Request

  • CONFIDENTIAL CONTACT / REQUEST FOR INFORMATION

  • If we can't call you, we need an email address.
  • MEDICAL INFORMATION

  • COUNSELING AND INFORMATION DESIRED

    Please select all that apply
  • QUESTIONS

  • REQUEST APPOINTMENT TIME AND LOCATION

    Please note: You will receive a phone call or email to confirm your appointment time.
  • Waynesboro Clinic - Corner of 13th St & Magnolia Ave - (540) 943-1700

  • Staunton Clinic - 1020 North Augusta St - (540) 885-6261

  • Lexington Clinic - 631 Waddell St - (540) 448-0148