Putting Relationships at the Forefront of the Healthcare Experience

Dr. Blankenship is a SELECT PROVIDER for BC/BS

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Dr. Blankenship is a SELECT PROVIDER for BC/BS


  • Home
  • How We Help
  • About Us
  • New Patient
  • Contact Us
  • Blog

New Patient Application

New Patient Application

New Patient Application

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Please complete the new patient application below and either fax it to us at (256) 534-7268 or drop it off at our office.

New Patient Packet

New Patient Application

New Patient Application

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Once your application is approved, please complete the new patient packet in order for us to set up your initial appointment.  You can drop off your new patient packet, fax it or mail it to us.

New Patient Application

New Patient Application NEW (2) (1) (docx)Download

New Patient packet paperwork

New Patient Packet 2020 - 16 (docx)Download

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