Patient & Visitor Information

Request An Appointment

This form is for NON-URGENT APPOINTMENTS ONLY.


Please complete the information below. Once submitted, our office will contact you within one business day to schedule your appointment. If you have an emergency, call 911 immediately or go to your nearest emergency room. We do not respond to emergencies through this website.

If you’d like to download and print the form instead you can do so here:


Pain Management Patient Registration

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We have decades of combined experience
in primary care! Whether you have a cold
or just need a checkup, we’re here for you!

(904) 513-3240

© 2022 Emed Multispecialty Group. All rights reserved.