Skip to main content
IALVS logo

100 E. Main St., Mascoutah, IL 62258

Home » Contact Us » Appointment Request Form

Appointment Request Form

  • Please fill in the form below to request an appointment. We will call you back to schedule.
  • Please provide a reason for your appointment. Details are stored securely and not sent by email.
    Please let us know if you are a new or existing patient.
  • :
  • This field is for validation purposes and should be left unchanged.
Adjust Text Size Normal Large Extra Large