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Request an Appointment

Please note: This is a REQUESTED appointment, NOT a scheduled appointment. You will receive an email or call regarding the details of your request.  
***Please include a phone number where you may be reached.  
Thank you!

Contact information

First Name
Last Name
Phone

Appointment details

Preferred Date
Alternative Date 1
Alternative Date 2
Time
Reason for Appointment
Preferred Provider
Comments and Questions
Maximum of 250 characters

Please note that the date and time you requested may not be available. We will contact you to confirm your actual appointment details.

9335 Blakeney Centre Dr Ste 100
Charlotte, NC 28277

Mon - Thu: 7:00AM - 4:00PM

Fri: 7:00AM - 1:00PM

Sat - Sun: Closed