My Telfair Doc Appointment Request

Request an appointment with a My Telfair Doc physician

Please fill out the form below, and we will contact you shortly to verify a time for you to see one of our physicians. Please be advised this is for appointment requests only. Any medical questions would be addressed at your appointment. Which doctor would you like to see?  *First Name  *Middle Name Last Name  *Date of Birth  *Home Address  *City  *State  *Zip Code  *Phone  *Email Address  *Reason for Visit  *Are you a self-pay patient (no insurance)?  *Please provide your insurance company and plan. (If you do not have insurance, please put N/A.)  *Insurance ID Number  *Former OB/GYN Doctor Primary Care Physician