Request an Appointment

If you would like to request an appointment, please complete and submit the form below.  We’ll call you as quickly as possible to set up your visit.

For Telemed click here.


If your child is sick and needs to be seen today, please do not use this form, but call us at 770-429-1005 so that we can get you in even more quickly.  After hours, this number can also be used to reach the doctor on call.

Once your appointment is set up we’ll send you a confirmation message using the the contact method you list below as your preference. We will do our best to meet all requests regarding date, time and which practitioner you prefer, but we cannot guarantee appointment availability.  If your preference is not available, we’ll contact you with alternatives.  This form is for requests only and does not confirm your appointment.  Please wait for a confirmation call or message before coming to the office in case we must offer you alternatives for time and practitioner.

Parent's Name: *

Patient's Name: *

Patient's DOB: *

Patient's Age: *

Phone Number: *

How would you like us to contact you? *

New or Existing Patient: *

Date Requested: *

No same day or weekend requests on this form. Please call for these appointments.

Time Requested: *

Practitioner Requested: *

Visit Type: *

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