STEP 2: PATIENT INFORMATIONThank you for booking a home visit with Lake James Urgent Care. Please complete the form immediately following booking.Home Visit Patient Name * Patient Date of Birth * Location Type for Visit * Home Office Lake / Recreation OtherOther Location Address/Description * Medical Need * Patient's medical history: * Best way to reach you when we arrive: * Confirm Appt Date * Confirm Appt Time * 121234567891011 : 00153045 AMPM Submit