New Patient Application

When you fill out your application, you can:

  • Drop it off at our office
  • Fax it to (205) 349-4015
  • Upload below

Please allow us time to review your application. Once you are accepted as a new patient, you will receive a welcome letter and you will have 60 days to call our office to schedule your initial visit. 


Thank you for considering to be our patient and let Taylorville Family Medicine take care of your medical needs.