Appointment Request

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Need an appointment?

You may use this form to schedule an appointment with us by e-mailing a request to us with this form and we will contact you to scheduel the appointment.

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Name:
Email Address:
PHONE NUMBER(locally) can be reached at:
What would be the best way to contact you by: E-mail
Phone
In Person
Please state best time to call you to set up the appointment if we call you?
If we set stuff up via e-mail will you be able to check your e-mail to make the appointment YES
NO
I know to call 518 636 1034 atleast 48 hours in advanced to confirm the appointment if it is set up on the web YES
NO
Have you read the rules of our program and understand what our program is about? YES
NO
UNSURE
I understand if I can't make an appointment I need to cancel with in 48 hours so we are aware you can't make it. YES
NO

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