EPIC Health Partners LLC | Comprehensive Behavioral Health Services

Request an Appointment

Request an Appointment Please do not use this form if you have an urgent medical problem or you need to reschedule an existing appointment. Instead, contact our office at (434) 835-4601. After you submit your request, our appointment scheduler will respond within 48 hours. See below for forms to complete.

First Name *

Last Name *

Email Address *

Phone Number *

Date of Birth *

Street Address *

City *

Zip Code *

State *

Location *

Type of Patient *

New Patient Existing patient

Type of Appointment *

Follow-up New Problem

Insurance Carrier *

Insurance ID Number *

Desired Date *

Desired Time

Please Note: Any information submitted using this form is transmitted securely and held in the strictest of confidence, protecting your privacy.

* = Input is required

Request an Appointment

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Request an Appointment