This feature is to be used for WELL CHILD VISITS, ADD & ADHD Visits AND PHYSICAL EXAM appointments only. This feature should be used ONLY for well child visits ADD & ADHD visits and physical exams.

Our staff will check availability for these appointments during our regular weekday business hours and make every effort to respond to your request within 72 hours.

If this is an emergency, call your doctor's office and indicate to the answering service that it is an emergency, call 911, or take your child to a hospital Emergency Room. If your child is ill or a new patient to our practice, please call us to schedule an appointment by phone.

ONLINE APPOINTMENT FORM

*Denotes required field

Child's First Name* Child's Last Name*

Sex* Male Female Date of Birth* Month Day Year

Daytime Phone* Your E-Mail*

Appointment Type*

Physician
IMPORTANT: This should not be used for urgent matters. In emergencies, call your doctor's office, call 911 or visit an emergency room.

For online appointments, we will attempt to respond within 72 hours. Please select your dates accordingly. If you need a quicker response, please call.
Date: Time Range: AM PM

Notes:


For online appointments, we will attempt to respond within 72 hours. Please select your dates accordingly. If you need a quicker response, please call.
Date: Time Range: AM PM

Notes:

For online appointments, we will attempt to respond within 72 hours. Please select your dates accordingly. If you need a quicker response, please call.
Date: Time Range: AM PM

Notes:
Chillicothe or Waverly Office? Chillicothe Office   Waverly Office

Are you willing to see another physician/clinician if yours is unavailable?
YES NO



 



   

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