Schedule or Re-Schedule an Appointment

Schedule an appointment.
Re-schedule an appointment.

An appointment can be made by calling (662) 534-9042 or you may use the following appointment form. Fill in the blanks below and someone will either email or telephone your appointment time.

If your injury is work related, you must call our appointment line. Workmen's Comp injury appointments cannot be made online.

Please provide the following information.

Full Name:
*Email:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Cell Phone:
Date of Birth:
Social Security Number: (Opional - for verification purposes)

Have you ever been a Creekmore Clinic patient?
Yes No

Has a non-Creekmore Clinic physician treated you for this problem?
Yes No

What problem brings you to Creekmore Clinic?

Please list your primary insurance company?

Please list your secondary insurance company?

Please choose the doctor you wish to see:

For confirmation of your appointment, please indicate the best method to contact you.
Phone Email Address
Please provide phone number or email address:

I prefer a:
Morning appointment

Afternoon appointment

Thank you for using our online form. We will contact you within 24 hours with information regarding your appointment.