1. Please include a drop down where individuals have to write the following information to schedule an appointment with their provider.



Phone #

Provider Name

Appointment Date Request

Time (Please annotate 2-3 times you’ll be available on this date for 1hr)

Message Box

(Please have this information routed to email address bwhitfield@symedica.net but do not allow the patient to see the email. Also forward an automatic email to the patient/client letting them know that the email was sent/received with the following message:

Thank you! A reply will be sent shortly to confirm your exact appointment date and time for you Provider.[/vc_column_text][/vc_column][/vc_row]