All requests are reviewed during normal business hours and confirmed as quickly as possible.

Submitting this form does not guarantee an appointment. This is a request of date and time only.

If a response is not received within your required time period or if this is an emergency, please call us at (304) 594-1124.

Appointment Request Form

Client Information

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Services Requested

Payment is required on the day services are provided. We accept cash, checks, VISA, MasterCard, and Discover. If you have concerns about your charges, please request an estimate prior to receiving services or call (304) 594-1124.