WJMC - West Jefferson Medical Center

WJMC - West Jefferson Medical Center

The Family Doctors
Physician Office Scheduling


If you have an emergency call 911 immediately or go to the nearest Emergency Room.
WE DO NOT RESPOND TO EMERGENCIES THROUGH THIS WEBSITE.


Identification
First Name:   Middle Init:
Last Name:  
Address:  
City:   State:  
Zip:  
Returning Patient?:  
Gender:  
Marital Status:  
Employment Status:  
Employer:  
Date of Birth:
Last Four Digits of SSN:   Enter 0000 if not applicable.
Primary Phone:
Secondary Phone:
Email Address:    
How do you want
us to contact you?:
Insurance Type/Name:
Reason for Visit:

Preferred Date/Time
Date:
Time:  
Preferred Provider
Location:  
Provider:  
 



REMINDER
Please contact us if you are unable to make it to this appointment. Please bring your insurance card, picture ID and arrive 15 minutes early.

Thank you for choosing West Jefferson Medical Center and The Family Doctors for your healthcare needs.








WJMC Family Doctors West Jeff Center For Family Health WJMC Center For Surgical Weight Loss WJMC Urology Specialists WJMC Cardiac and Vascular Services WJMC Neurology WJMC Stroke Center WJMC Spine Care WJMC Community Cancer Program WJMC Business Advantage WJMC Orthopaedics WJMC Adult Health Day Care WJMC Diabetes WJMC Fitness Center WJMC Diagnostic Imaging WJMC Family Birth Place WJMC Pediatrics WJMC Gift Shop WJMC Hyperbarics WJMC Surgical Services WJMC Pulmonary Services WJMC Rehabilitation WJMC Sleep Disorders Center WJMC Wound Care Center