e-Visit Patient Self-Exam

Please fill this out to the best of your knowledge.

How would you like to be contacted?
How are you feeling? (Follow up patients only)
What are your current symptoms? (Check all that apply)
Nose/Head Symptoms
Throat Symptoms
Ear Symptoms
GI/Stomach Symptoms
Skin Symptoms
Eye symptoms
Chest Symptoms

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To Schedule An Appointment

Call 706.421.1700​