(850) 219-2273

(850) 692-2868

(850) 201-2410

Hours of Operation

Monday - Thursday
8:30AM - 5:00PM
Friday - Sunday

Contact Us

If you’d like to submit a billing question, appointment request, refill request, or new patient request, please use this form to contact us.

Patient Request
Your Name
Your Name
Are you contacting Wilson Family Medicine on your behalf or for your child?
Patient Name
Patient Name

Appointment Request

Appointment Type
Please provide a short description for the reason you need to be seen.
How soon do you want to be seen?
Preferred Day(s) of the Week
Preferred Time(s) of the Day
Preferred Time(s) of the Day

Mediciation/Refill Request

Is this an existing or new medication request?
Please describe the reason for the medication (illness, injury, etc.) and any other relevant details.
Do you have any allergies to medications?

Medication Request

New Patient Request

Thank you for considering becoming a new patient at Wilson Family Medicine. Please note, Wilson Family Medicine is not always accepting new patients.
Primary Insurance
Desired time frame to be seen
Physician Preference
Common examples include: moving to Tallahassee area, current physician retired, current physician no longer takes my insurance, no longer can be seen by pediatrician, etc.
Please describe your medical history including conditions, surgeries, etc.
Do you take any medications?

Medication List

Were you referred to Wilson Family Medicine by anyone?

Billing Question

What is your billing question related to?
Policy Coverage
Laboratory Invoice
Please provide any additional details about the laboratory invoice.

Maximum file size: 25MB

Use this to upload your new insurance card, laboratory invoice, or any other relevant billing information

Acceptable file types include: .JPG, .JPEG, .PNG, .TIFF, .PDF

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