We appreciate you taking the time to fill out a quick form so that we may serve you better.

 

Online booking is for new patients only. If you are an existing patient please call the office at 205.419.1595 to schedule an appointment.

 

*Credit card is not charged up front, information is used to hold appointment and in the case of a no-show card is charged for $150.00.

Name *
Name
Phone *
Phone
Type of appointment? *
What type of appointment are you requesting?
Card is not charged. This is used for holding appointment and no-show fee of $150.
Number on back of card