Appointment Request

Request an appointment with Primary Medicine Associates.

COD10 AssetID

245770

External ID

362

Integration Source

COD10

Integration Source URL

https://www.eastalabamahealth.org/find-a-service/primary-care/appointment-request

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.

COD10 AssetID

245770

External ID

362

Integration Source

COD10

Integration Source URL

https://www.eastalabamahealth.org/find-a-service/primary-care/appointment-request

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.

Comments *

Preferred Location

Please choose which primary care office you would prefer to visit.

Auburn

Smiths Station

Roanoke

Preferred Day of Week

Preferred Time of Day

Preferred Physician

COD10 AssetID

245770

External ID

362

Integration Source

COD10

Integration Source URL

https://www.eastalabamahealth.org/find-a-service/primary-care/appointment-request

Alert block content

Appointment Request

Ready to Speak with a Primary Care Provider?

Preferred Location