AppointmentsPlease use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!Name* First Last Phone*Email* Location*DecaturClarkstonJonesboroLithia SpringsPreferred Date* MM slash DD slash YYYY Preferred TimeMorningAfternoonEveningPreferred contact methodPhoneEmailBothWere you involved in an auto accident? Yes No We can help you find free legal advice. Do you need help choosing an attorney? Yes No Does Not Apply How did you hear about usBillboardDriving byFacebookGeorgia Chiropractic AssociationGoogleInstagramInsurance NetworkMedical DoctorNews BroadcastOther Social MediaReferred By FriendReferred By AttorneyVA HospitalName of person who referred youUpload FileMax. file size: 256 MB.insurance card, id, medical referral, police reportNature of VisitNameThis field is for validation purposes and should be left unchanged.