Online Referral (For New Clients)

Please email us at info@piedmontbs.com after filling the below form to confirm the submission. Our clinics are open and appointments are via video now due to Covid. Please fill the information below and click the submit option at the bottom. If there any issues, please use Laptop or Computer. You also can try to use Google chrome browser on smartphone if needed. Please resubmit the request again if you do not get reply within 24 hours or emails us at info@piedmontbs.com

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Click or drag a file to this area to upload.