Thank you for choosing South Plains Rural Health Services. To request an appointment with one of our doctors, please fill in the information below.

Patient Information

First Name *

Middle Initial

Last Name *

Birth Date (MM/DD/YYYY) *

Daytime Phone *

Evening Phone

Is this your first visit to our offices? *

Yes

No

Date and Time

Please select the best date & time for your appointment. We will try to accomodate your request. You will receive a callback within 24hrs to confirm the exact time your appointment will be scheduled. Call our office at 806-894-7842 with any questions.

Date * 🛈 +

Time * 🛈

Appointment Information

If you have a Physician at South Plains Rural Health currently, please indicate below

Beatriz Garza - Family NP - Levelland	Kelly Nix - Dental Hygienist - Levelland	Kelly Nix - Dental Hygienist - Lamesa	Michelle Howell -Womens Health NP - Levelland	Lance Tolbert - LPC - Big Spring
Lance Tolbert - LPC - Levelland	Lance Tolbert - LPC - Lamesa

Please describe the reason for this visit *