Appointment Request

Request an appointment with Primary Medicine Associates.

Ready to Speak with a Primary Care Provider?

Use the form below to request an appointment with one of our primary care providers. After we receive your message, we will reach out to you to make sure we have all the information needed before your first visit.

First Name *

Last Name *

Address 1

Address 2

City

State or Province

Zip or Postal Code

Phone Number *

Email Address *

Birth Date *

Social Security Number (Last 4 Digits)

Please only provide the last four digits.

What insurance will you be filing for this visit? *

Comments *

Preferred Location

The following offices are currently accepting new patients.

Smiths Station

Roanoke

Preferred Day of Week

Preferred Time of Day

Preferred Physician

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Appointment Request

Preferred Location