APPOINTMENT REQUEST
Thank you for contacting Total Family Care for an appointment! We will get back with you as soon as possible to schedule you to come in.
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Email *
Are you an ALIEF ISD employee/dependent? *
Are you a NEW or ESTABLISHED patient? *
What is your DATE OF BIRTH? *
First Name *
Last Name *
Phone Number *
Do you prefer we CALL or TEXT you to schedule this appointment? *
Insurance *
What is the reason for your visit? *
Required
Have you completed a COVID vaccine series? *
Please check off any symptoms you have experienced in the past 2 weeks: *
Required
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