(828) 221-0121
Access Patient Portal
HOME
ABOUT US
Javid Baksh, DO
Christopher Mallard, MD
Ken Barrow, PA-C
Chris Campbell, PA
Kathy Lewis, ANP- BC
Events
Videos
CONDITIONS
TREATMENTS
FOR PATIENTS
New Patient Information Forms
Office and Billing Policy
FOR PHYSICIANS
Physician Contact Form
Physician Referral Form
CONTACT US
Asheville Location
Columbus Location
Easley Location
Wilmington Location
HOME
ABOUT US
Javid Baksh, DO
Christopher Mallard, MD
Ken Barrow, PA-C
Chris Campbell, PA
Kathy Lewis, ANP- BC
Events
Videos
CONDITIONS
TREATMENTS
FOR PATIENTS
New Patient Information Forms
Office and Billing Policy
FOR PHYSICIANS
Physician Contact Form
Physician Referral Form
CONTACT US
Asheville Location
Columbus Location
Easley Location
Wilmington Location
Physician Referral Form
Physician Fast Track Referral Form
Patient Name
*
First
Last
Patient Phone Number
*
Patient DOB
Physician Name
*
First
Last
Physician Practice Name
*
Physician Address
*
Line 1
Line 2
City
State
Zip Code
Physician Phone Number
*
Physician Fax Number
Physician Email
Preferred Method of Contact
*
Phone
Fax
Email
Mail
Urgency of Consult
Routine
Urgent (within 48 hours)
Reason for Consult
Type of Consult Requested
Evaluation and Management
Evaluation and Recommendations Only
Narcotic Detoxification Evaluation
Other
Name
Submit
Call Now
Send Message
Start typing and press Enter to search
