Request Appointment Name (first, last) Phone Number (area code) Email Address Address City State Zip Code Were you referred to our practice by a current patient? Reference Name Which day(s) of the week are you available? Which day(s) of the week are you available? No Preference Monday Tuesday Wednesday Thursday Which time(s) of the week are you available? Which time(s) of the week are you available? No Preference Morning Afternoon Evening Please explain your symptoms. 8 + 5 = Submit Hours 7:30am - 5:00pm Tuesday's - Thursday's Alternating Monday's & Friday's Address 610 Miller Blvd. PO Box 247 Havelock, NC 28532 Phone +1 (252) 447-1135 Emergency Care Notice of Privacy Practices