Thank You for Enrolling in a COVID-19 Screening

We like to keep things simple, and that’s why we put this convenient scheduling form on our site. But if forms aren’t your thing, we would be very glad to take your call. Or you can email us directly at info@birminghamdpc.com.

Name

Phone Number

Email

Best Day for Screening

Callback Time 1st Choice

Callback Time 2nd Choice

Callback Time 3rd Choice

This form is not HIPAA compliant. If your message contains medical information and/or you are not comfortable contacting Birmingham DPC using this form, please do not click the SUBMIT button below. Instead, please call us via telephone at (205) 582-3322. Thank you.

info@birminghamdpc.com

* Our patients always have access to our physician via multiple modalities at all times. Prospective patients without appointments are recommended to call our office or email prior to stopping by as above hours may vary.

(205) 582-3322

Powered by The Creative Offices