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Patient SSN    Patient Name      Guardian (if minor)          Home Address      Home Address 2    City      State      Zip Code            Telephone (work)    Telephone (home)      Telephone (cell)    Email Address          Sex    Male   Female Date of Birth    Calendar         Insurance Provider    Medicaid Number (if applicable)         Physician Requested    Dr. Butehorn, Jr. Dr. Foster Dr. Rucker Dr. Butehorn, III Dr. Weir First Available       Office Requested    Spartanburg - North Grove Greer       Appointment Requested    AM PM       Referring Physician    Referring Office Contact Name    Referring Office Phone    Reason for Appointment?          Send   Cancel

(864) 849-9550 (Main)    (864) 279-8920 (local - Spartanburg)

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