If you need to reschedule an existing appointment, or if you require immediate attention, please contact our practice directly. – indicates a required field Patient Name Parent Name Email Phone Type of Appointment - None -Need ConsultationMissed AppointmentNeed ElasticsEmergency Preferred Location - Select -MattoonDecatur Preferred Date Preferred Time AM / PM - Select -AMPM Comments Ignore this text box. It is used to detect spammers. If you enter anything into this text box, your message will not be sent.