{"id":67,"date":"2013-12-20T22:56:39","date_gmt":"2013-12-20T22:56:39","guid":{"rendered":"\/?page_id=67"},"modified":"2026-03-10T11:31:48","modified_gmt":"2026-03-10T16:31:48","slug":"appointments","status":"publish","type":"page","link":"https:\/\/premiermedicalgrp.com\/es\/patient-resources\/appointments\/","title":{"rendered":"Solicitar una cita"},"content":{"rendered":"<p><span style=\"color: #d30000;\"><strong>PLEASE NOTE:<\/strong> <em><strong>Your information will be sent to the appointments staff by unencrypted email. If you would prefer to contact us directly via phone please call one of our office locations directly:<\/strong><\/em><\/span><\/p>\n<ul>\n<li>WEST: 251.341.3300<\/li>\n<li>EAST \u2011 EYE: 251.470.8844<\/li>\n<li>EAST \u2011 ENT: 251.470.8877<\/li>\n<li>PROVIDENCE \u2011 ENT: 251.633.2667<\/li>\n<li>PROVIDENCE \u2011 EYE: 251.635.0919<\/li>\n<li>DAPHNE \u2011 EYE: 251.470.8844<\/li>\n<li>DAPHNE \u2011 ENT: 251.333.4055<\/li>\n<li>FOLEY &#8211; EYE: 251.470.8844<\/li>\n<li><a href=\"https:\/\/premiermedicalgrp.com\/contact\/satellite-locations\/\">SATELLITE LOCATIONS: Click Here<\/a><\/li>\n<\/ul>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar 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class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_4' id='gform_4'  action='\/es\/wp-json\/wp\/v2\/pages\/67#gf_4' data-formid='4' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Lcb4ZscAAAAAPWcGbBcs_jtS6bsiguKuv0Ahgbx' data-tabindex='0'><input id=\"input_35be03f21148cf7daf00d9edcddf7231\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_35be03f21148cf7daf00d9edcddf7231\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_4_62\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below 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class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_2'>Patient Birthdate<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_2' id='input_4_2' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_4_2_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_4_2_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_4_2' class='gform_hidden' value='https:\/\/premiermedicalgrp.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_4_3\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_3'>Patient Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_4_3' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_4_4\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_4'>Patient Phone Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_4_4' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_37\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Were you referred to us by another physician?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_37'>\n\t\t\t<div class='gchoice gchoice_4_37_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='Yes'  id='choice_4_37_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_37_0' id='label_4_37_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_37_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_37' type='radio' value='No'  id='choice_4_37_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_37_1' id='label_4_37_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_36\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_36'>Referring Physician<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_4_36' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_4_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What type of service do you need?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_6'>\n\t\t\t<div class='gchoice gchoice_4_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Eyes'  id='choice_4_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_6_0' id='label_4_6_0' class='gform-field-label gform-field-label--type-inline'>Eyes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Ear, Nose and Throat'  id='choice_4_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_6_1' id='label_4_6_1' class='gform-field-label gform-field-label--type-inline'>Ear, Nose and Throat<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Select an office location:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_7'>\n\t\t\t<div class='gchoice gchoice_4_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='West Office (3701 Dauphin)'  id='choice_4_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_0' id='label_4_7_0' class='gform-field-label gform-field-label--type-inline'>West Office (3701 Dauphin)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='East Office (2880 Dauphin)'  id='choice_4_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_1' id='label_4_7_1' class='gform-field-label gform-field-label--type-inline'>East Office (2880 Dauphin)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Providence Office'  id='choice_4_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_2' id='label_4_7_2' class='gform-field-label gform-field-label--type-inline'>Providence Office<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Daphne Office'  id='choice_4_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_3' id='label_4_7_3' class='gform-field-label gform-field-label--type-inline'>Daphne Office<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Foley Office'  id='choice_4_7_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_4' id='label_4_7_4' class='gform-field-label gform-field-label--type-inline'>Foley Office<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_28\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_28'>West Office Eye Providers (Optional)<\/label><div class='ginput_container ginput_container_select'><select name='input_28' id='input_4_28' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Select a Provider --<\/option><optgroup label=\"West Office Location: Eye\"><option value='Dr. Ronni Ferris-Metzger' >Dr. Ronni Ferris-Metzger<\/option><option value='Dr. Curtis Graf' >Dr. Curtis Graf<\/option><option value='Dr. Charles S. Mosteller' >Dr. Charles S. Mosteller<\/option><option value='Dr. Matthew W. Mosteller' >Dr. Matthew W. Mosteller<\/option><option value='Dr. C. Drew Salisbury' >Dr. C. Drew Salisbury<\/option><option value='Dr. Andrew P. Terry' >Dr. Andrew P. Terry<\/option><option value='Dr. Christopher James Walton' >Dr. Christopher James Walton<\/option><option value='Dr. Edmond Wright' >Dr. Edmond Wright<\/option><\/optgroup><\/select><\/div><\/div><div id=\"field_4_29\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_29'>West Office ENT Providers (Optional)<\/label><div class='ginput_container ginput_container_select'><select name='input_29' id='input_4_29' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Select a Provider --<\/option><optgroup label=\"West Office Location ENT\"><option value='Dr. Kimberly A.Elliott' >Dr. Kimberly A.Elliott<\/option><option value='Dr. J. Mark Harrison' >Dr. J. Mark Harrison<\/option><option value='Dr. B. Jake Johnson' >Dr. B. Jake Johnson<\/option><option value='Dr. Alfred M. Neumann, Jr.' >Dr. Alfred M. Neumann, Jr.<\/option><option value='Dr. James R. Spires' >Dr. James R. Spires<\/option><\/optgroup><\/select><\/div><\/div><div id=\"field_4_30\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_30'>East Office EYE Providers (Optional)<\/label><div class='ginput_container ginput_container_select'><select name='input_30' id='input_4_30' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Select a Provider --<\/option><option value='optgroup-startDr. Stuart F. Ball' >East Office Location: EYE<\/option><option value='Dr. Stuart R. Ball' >Dr. Stuart R. Ball<\/option><option value='Dr. Jay A. Brown' >Dr. Jay A. Brown<\/option><option value='Dr. Ryan C. Burton' >Dr. Ryan C. Burton<\/option><option value='Dr. Sean M. Carter' >Dr. Sean M. Carter<\/option><option value='Dr. Mark J. Douglas' >Dr. Mark J. Douglas<\/option><option value='Dr. Richard J. Duffey' >Dr. Richard J. Duffey<\/option><option value='Dr. Gregory R. Jackson' >Dr. Gregory R. Jackson<\/option><option value='Dr. Ben King' >Dr. Ben King<\/option><option value='Dr. H. Christopher Semple' >Dr. H. Christopher Semple<\/option><option value='Dr. William F. Stringer, Jr.' >Dr. William F. Stringer, Jr.<\/option><option value='Dr. Valerie L. Vick' >Dr. Valerie L. Vick<\/option><\/optgroup><\/select><\/div><\/div><div id=\"field_4_32\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_32'>East Office ENT Providers (Optional)<\/label><div class='ginput_container ginput_container_select'><select name='input_32' id='input_4_32' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Select a Provider --<\/option><optgroup label=\"East Office Location: ENT\"><option value='Dr. Kent L. Burton' >Dr. Kent L. Burton<\/option><option value='Dr. Michael Lee' >Dr. Michael Lee<\/option><option value='Dr. Andrea McMurphy' >Dr. Andrea McMurphy<\/option><option value='Dr. Jessica Southwood' >Dr. Jessica Southwood<\/option><option value='Dr. Brian P. Sullivan' >Dr. Brian P. Sullivan<\/option><option value='Dr. Ron Swain, Jr.' >Dr. Ron Swain, Jr.<\/option><option value='Dr. John Wilson' >Dr. John Wilson<\/option><option value='Rachael Rutledge, NP' >Rachael Rutledge, NP<\/option><\/optgroup><\/select><\/div><\/div><div id=\"field_4_31\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_31'>Providence Office EYE Providers (Optional)<\/label><div class='ginput_container ginput_container_select'><select name='input_31' id='input_4_31' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Select a Provider --<\/option><optgroup label=\"Providence Office Location: EYE\"><option value='Dr. Stuart R. Ball' >Dr. Stuart R. Ball<\/option><option value='Dr. Mark J. Douglas' >Dr. Mark J. Douglas<\/option><option value='Dr. Ronni Ferris-Metzger' >Dr. Ronni Ferris-Metzger<\/option><option value='Dr. Charles F. Jones' >Dr. Charles F. Jones<\/option><option value='Dr. Alinda Guynes McGowin' >Dr. Alinda Guynes McGowin<\/option><option value='Dr. Jeffery A. Morrow' >Dr. Jeffery A. Morrow<\/option><option value='Dr. Timothy B. White' >Dr. Timothy B. White<\/option><\/optgroup><\/select><\/div><\/div><div id=\"field_4_33\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_33'>Providence Office ENT Providers (Optional)<\/label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_4_33' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Select a Provider --<\/option><optgroup label=\"Providence Office Location: ENT\"><option value='Dr. Kent L. Burton' >Dr. Kent L. Burton<\/option><option value='Dr. Andrea B. McMurphy' >Dr. Andrea B. McMurphy<\/option><option value='Dr. Brian P. Sullivan' >Dr. Brian P. Sullivan<\/option><option value='Dr. Ron Swain, Jr.' >Dr. Ron Swain, Jr.<\/option><option value='Rachael Rutledge, NP' >Rachael Rutledge, NP<\/option><\/optgroup><\/select><\/div><\/div><div id=\"field_4_34\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_34'>Daphne Office EYE Providers (Optional)<\/label><div class='ginput_container ginput_container_select'><select name='input_34' id='input_4_34' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Select a Provider --<\/option><optgroup label=\"Daphne Office Location: EYE\"><option value='Dr. Jay A. Brown' >Dr. Jay A. Brown<\/option><option value='Dr. Ryan C. Burton' >Dr. Ryan C. Burton<\/option><option value='Dr. Mark J. Douglas' >Dr. Mark J. Douglas<\/option><option value='Dr. Ronni Ferris-Metzger' >Dr. Ronni Ferris-Metzger<\/option><option value='Dr. Ben F. King IV' >Dr. Ben F. King IV<\/option><option value='Dr. Alinda Guynes McGowin' >Dr. Alinda Guynes McGowin<\/option><option value='Dr. H. Christopher Semple' >Dr. H. Christopher Semple<\/option><option value='Dr. William F. Stringer, Jr.' >Dr. William F. Stringer, Jr.<\/option><option value='Dr. J. Ryan Turner' >Dr. J. Ryan Turner<\/option><option value='Dr. Valerie L. Vick' >Dr. Valerie L. Vick<\/option><option value='Dr. Timothy B. White' >Dr. Timothy B. White<\/option><\/optgroup><\/select><\/div><\/div><div id=\"field_4_38\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_38'>Daphne Office ENT Providers (Optional)<\/label><div class='ginput_container ginput_container_select'><select name='input_38' id='input_4_38' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Select a Provider --<\/option><optgroup label=\"Daphne Office Location: ENT\"><option value='Dr. Alfred M. Neumann, Jr.' >Dr. Alfred M. Neumann, Jr.<\/option><option value='Dr. Michael Rhodes Lee' >Dr. Michael Rhodes Lee<\/option><option value='Dr. Jessica E. Southwood' >Dr. Jessica E. Southwood<\/option><option value='Dr. John S. Wilson' >Dr. John S. Wilson<\/option><option value='Dr. Kent L. Burton' >Dr. Kent L. Burton<\/option><\/optgroup><\/select><\/div><\/div><div id=\"field_4_35\" class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_35'>Foley Office EYE Providers (Optional)<\/label><div class='ginput_container ginput_container_select'><select name='input_35' id='input_4_35' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Select a Provider --<\/option><optgroup label=\"Foley Office Location EYE\"><option value='Dr. Ryan C. Burton' >Dr. Ryan C. Burton<\/option><option value='Dr. Sean M. Carter' >Dr. Sean M. Carter<\/option><option value='Dr. Mark J. Douglas' >Dr. Mark J. Douglas<\/option><option value='Dr. Joseph C. Harrell' >Dr. Joseph C. Harrell<\/option><option value='Dr. H. Christopher Semple' >Dr. H. Christopher Semple<\/option><option value='Dr. Valerie L. Vick' >Dr. Valerie L. Vick<\/option><\/optgroup><\/select><\/div><\/div><div id=\"field_4_51\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_51'>Email Group 1 - EYE West (For admin purposes only)<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_4_51' type='text' value='Group 1' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_56\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_56'>Email Group 1 - ENT West<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_4_56' type='text' value='Group 1' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_55\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_55'>Email Group 2 - Eye East<\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_4_55' type='text' value='Group 2' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_59\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_59'>Email Group 2 - Eye Daphne<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_4_59' type='text' value='Group 2' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_58\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_58'>Email Group 2 - Eye Foley<\/label><div class='ginput_container ginput_container_text'><input name='input_58' id='input_4_58' type='text' value='Group 2' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_54\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_54'>Email Group 3 - ENT East<\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_4_54' type='text' value='Group 3' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_61\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_61'>Email Group 3 - ENT Daphne - Not Dr. Newman Jr.<\/label><div class='ginput_container ginput_container_text'><input name='input_61' id='input_4_61' type='text' value='Group 3' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_49\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_49'>Email Group 7 - ENT Daphne &amp; Dr. AL Newman Jr<\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_4_49' type='text' value='Group 7' class='large'    placeholder='Group 7'  aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_53\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_53'>Email Group 4 - ENT Providence<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_4_53' type='text' value='Group 4' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_4_52\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_4_52'>Email Group 5 - 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If you would prefer to contact us directly via phone please call one of our office locations directly: WEST: 251.341.3300 EAST \u2011 EYE: 251.470.8844 EAST \u2011 ENT: 251.470.8877 PROVIDENCE \u2011 ENT: 251.633.2667 PROVIDENCE \u2011 EYE: 251.635.0919 DAPHNE \u2011 EYE: 251.470.8844 DAPHNE [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":74,"menu_order":14,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-67","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Online Appointment Request Form - Premier Medical Group<\/title>\n<meta name=\"description\" content=\"Fill out our online appointment request form to receive care at any one of our Mobile offices or area locations.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/premiermedicalgrp.com\/es\/patient-resources\/appointments\/\" \/>\n<meta property=\"og:locale\" content=\"es_MX\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Online Appointment Request Form - Premier Medical Group\" \/>\n<meta property=\"og:description\" content=\"Fill out our online appointment request form to receive care at any one of our Mobile offices or area locations.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/premiermedicalgrp.com\/es\/patient-resources\/appointments\/\" \/>\n<meta property=\"og:site_name\" content=\"Premier Medical Group | Eye &amp; 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