Request an Appointment

Fill out the form below and our office will call you within 24 business hours to schedule your first visit.

We currently accept:

Straight Georgia Medicaid
Dual Insurance: Medicare / Georgia Medicaid
VA CCN (with authorization/referral letter)
Georgia Medicaid – Amerigroup
Georgia Medicaid – Peach State Health Plan
Georgia Medicaid – CareSource
Tricare (with PCP authorization)
Self-pay

Commercial insurance accepted starting February 2027.

Fill out the form

It takes about 5 minutes. Have your insurance card handy.

We’ll call you

Our office will call you within 24 business hours.

Complete your forms

Finish your paperwork online in the client portal before your visit.

Appointment request

Fields marked * are required. If you are filling this out for someone else, enter the patient’s information.

We are currently accepting new clients with straight Georgia Medicaid, dual Medicare / Georgia Medicaid, VA CCN (with an authorization/referral letter), Georgia Medicaid plans (Amerigroup, Peach State Health Plan, CareSource), Tricare (with PCP authorization), and self-pay. We will begin accepting commercial insurance in February 2027.

About the patient

First name

Last name

Date of birth

Age —

Contact information

Cell phone

Home phone (optional)

Email address A working cell number and an active email address are required to receive appointment information.

Emergency contact name

Emergency contact phone

Home address on the insurance card

City

State

ZIP

Insurance

Reason for appointment

Primary reason for today’s referral 0 / 2000

The information above is correct, and Willow Oak may contact me by phone, text, and email about this request.