Request Appointment

There are two ways for you to request an appointment electronically. If you have a My Health Record account, you can log in here and request an appointment there. Our response to your request will be submitted to you via My Health Record (not regular email) so be sure to check there.

If you are a new patient or do not use My Health Record, you can request an appointment using the form below. Your request will be submitted to our staff via email. We’ll respond via regular email within 2 hours during regular business hours. In some cases, we may follow-up via phone to make sure we have your appointment properly scheduled.

If you are a new patient or it has been more than two years since you were seen by us, please complete a Patient Demographics form and an Initial Patient Information form. Completing these ahead of time will save you time on the day of your appointment.

Use the form below for NON-URGENT appointments. For any other type of appointments and procedures please contact our office.

To request NON-URGENT appointment please complete the following form ( for any other type appointments and procedures please contact our office).

You can make, cancel, or reschedule appointments using this form.

* required fields

*Last Name:
*First Name:
*Home Phone:
*Work Phone:	Ext:
*E-Mail:
I am:	Established Patient           New Patient
*Date of Birth:	(MM/DD/YYYY)
*Insurance:	Aetna Us Healthcare/Prudential BCE Emergis/UP & UP Blue Choice HMO, POS, PPO Blue Cross/ Blue Shield Choice Care Humana PPO Cigna PPO/HMO/POS Humana HMO, PPO, POS Humana Gold Choice PFFS (Medicare) Humana Choice Care PPO (Medicare) CCN (Community Care Network) First Health Oglethorpe University Student Health Medicaid Medicare Great West HealthCare PPO/HMO/POS Private Healthcare Systems (PHCS) Southcare/Coventry Healthcare of GA State Health PPO High Deductible PPO Managed Indemnity Tricare/Champus PPO Unicare United Healthcare
*Address 1:
Address 2:
City:
State:	Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
*Group number:
*Member ID#:
*Policy Holder Name:
*Policy Holder Date of Birth:	(MM/DD/YYYY)
Location Preference:	Atlanta - Meridian Mark Alpharetta - Old Milton Parkway Any Location
Provider Preference:	Yvette M. Smith, MDJuanita Wyatt-Hathaway, MDMaria Arias, MDV. Leah Johnson, MDMichael Dawson, MDStanley Angus, MDSarah Jeffers, MDMelanie Turco, WHNP-BCRoza Pacifico, WHNP-BC

 

Please select an option below:

  Make a new appointment 

  Cancel my appointment for date (MM/DD/YYYY)   

  Reschedule my appointment from date (MM/DD/YYYY)   

 

To  request or to reschedule an appointment, please complete the form below.

*Type of visit:	Annual Obstetrical Post Partum Post Op Consultation Breast Exam Follow-Up Other NON-URGENT
Briefly state any specific scheduling request:

Schedule/Reschedule appointment for:

  First available time or 

 Preferred Date (mm/dd/yyyy)   

 Other:       Preferred week/month:

            Preferred days: Any Day   M     T    W     TH    F

            Preferred time:  Any Time  Early AM   Late AM       Early PM     Late PM   

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