DCLLP Standing Appointment Request Form
Since you are interested in finding a consistent time to see me, please fill out possible days/times below you could do, and I will let you know if any of those spots are available.  Once I receive your form I will contact you and let you know the time that worked, and then I will input you into the scheduling system.
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Email *
What is your first and last name?
 *
What is your cell #?
 *
Pick days of the week and times here that work!
8am
9am
10am
11am
12pm
2pm
3pm
4pm
5pm
Monday
Tuesday
Wednesday
Thursday
Friday
If your schedule is really flexible and most any time will work, check below which is best for you
How often would you like to come in?
 *
If there is anything else you'd like to let us know, please do so below.  Thank you for taking the time to fill this out.  We will get back to you ASAP to let you know what date we have available for your standing appointment.
A copy of your responses will be emailed to the address you provided.
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