Alpha Psychiatry - Appointment Request - Existing Patients

For Telemedicine appointments. We request you to download Zoom apps appropriate for your device. Download Zoom
Patient Name Patient Name * First Last
Phone Phone * - ### - ### ####
Date of Birth Date of Birth * / MM / DD YYYY
Email *
Appointment Request Type *

Appointment Request Type New Change Cancel

Please select Change or Cancel only if you have already scheduled an appointment, that was acknowledged by our staff. If not, just select New.
Existing appointment date (ONLY if you selected change/cancel above)

Enter the current appointment date that you wish to change or cancel.
If you selected New/Change above, when do you want the appointment? *

For urgent/crisis appointments, please call our office.
Preferred Day(s) of the Week

Preferred Day(s) of the Week Monday Tuesday Wednesday Thursday Friday
Preferred Time

Preferred Time Morning (8:30a - 10:30a) Midday (10:30a - 1p) Afternoon (2p - 3:30p) Evening (3:30p - 5p)

(Fridays, we close at 3PM)
Preferred Location

For telehealth appointments, please make sure that your payer/insurance covers telehealth post pandemic and your provider has not requested in-person visit
Preferred Provider in Cary
Preferred Provider in Durham
Additional Information (optional)

(such as appointment time/date and any other requirements needed to be given to the doctors/healthcare service providers)
Additional Information
Maximum of 500 characters allowed. Currently Entered: 0 characters.
Please note:

* Late cancellations may incur a minimum fee of $30.

Alpha Psychiatry - Appointment Request - Existing Patients

For Telemedicine appointments. We request you to download Zoom apps appropriate for your device. Download Zoom

Additional Information (optional)

Please note: * Late cancellations may incur a minimum fee of $30.

Please note:

* Late cancellations may incur a minimum fee of $30.