10 Street Name, City Name
Country, Zip Code
555-555-5555
mymail@mailservice.com
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Please note, this contact form is for non-emergent requests only. If you are a new patient or want to request an appointment, please go to the New Patient or Appointment Request page by clicking here.
This form is NOT to be used for a medical emergency.
If you are experiencing an urgent medical need you can call our on-call doctor at 336-274-4626 and for emergency situation you should call 911 or go to your closest emergency room.