Schedule An Appointment

Schedule an Appointment at TSGA

To make your first visit easier, we’ve simplified our registration process.

Complete the following information in the form below. You will be sent a summary of your submission to the email address you provide.

You will receive a call within 24-72 hours. If an emergency appointment is necessary, please call the office.

Questions?

Call 859-655-4490, leave a message and your call will be returned. If you are completing online, select “submit” at the bottom of the form and it will be e-mailed to us.

    Schedule an Appointment at TSGA

    To make your first visit easier, we've simplified our registration process. Complete the following information in the form below. You will be sent a summary of your submission to the email address you provide. You will receive a call within 24-72 hours. If an emergency appointment is necessary, please call the office.


    Are you a new patient with our practice? *

    Family Physician *

    Patient Date of Birth *

    Patient Age *

    Gender *

    Patient Address

    Street Address

    Address Line 2

    City

    State

    Zip Code

    Country

    Patient Home Phone

    Patient Work Phone

    Patient Cell Phone

    Relationship to Patient *

    Emergency Contact Phone Number *

    Preferred Pharmacy *

    Pharmacy Address

    Street Address

    Address Line 2

    City

    State

    Zip Code

    Country

    Pharmacy Phone Number *


    If Patient Is Under 18:

    Parent/Guardian Name:

    Parent/Guardian Address: (if different than above)

    Street Address

    Address Line 2

    City

    State

    Zip Code

    Country

    Parent/Guardian Date of Birth


    By clicking Submit, you are confirming that everything you have entered is accurate. You will be sent a summary of your submission to the email address you provided. The information will also be sent to our offices. Thank you.


    Business Hours

    Monday 8 AM - 5 PM
    Tuesday 8 AM - 5 PM
    Wednesday 8 AM - 5 PM
    Thursday 8 AM - 5 PM
    Friday 8 AM - 4 PM
    Saturday Closed
    Sunday Closed

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      First Name (required)

      Last Name (required)

      Phone (required)

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