Request an Appointment
Fill out the form below to request and appointment with the Doctor.
For Emergencies: Call (334) 280-3230
Step 1: Complete Patient Forms
In order to schedule a session with one of the clinicians, please fill out the patient forms first.
Please fill out the New Patient Intake Questionnaire and the Consent for Treatment form.
Then, as a final step, complete the form at the bottom of this page to schedule your session.
New Patient Forms
New Patient Questionnaire
Click below to fill out the form if you’re a new patient
Consent For Treatment
Click below to fill out the consent for treatment form
HIPAA Authorization Form
Click below to fill out the HIPPA Authorization form
Release of Medical Records
Click below to fill out the release of medical records form
Fill Out The Form
Or call — 334-280-3230