Roanoke Clinic Office Phone: 252.537.9176

Hours of Operation: M - F  7am - 5pm

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Medical/Legal Inquiry
  1. Use the form to submit your Medical/Legal inquiries. If this is a business or other personal inquiry, please browse back to the home page and click the button corresponding to your inquiry.
  2. Salutation(*)
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  3. First Name(*)
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  4. Last Name(*)
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  5. Title(*)
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  6. Company Name(*)
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  7. Company Address(*)
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  8. City(*)
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  9. State Abbreviation(*)
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  10. Zip Code(*)
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  11. E-mail(*)
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  12. Company Phone(*)
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  13. Phone Extension
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  14. Personal Cellphone(*)
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    XXX-XXX-XXXX (please include dashes)
  15. After completing your contact information, a second page of the form will appear for you to discuss the issue and note your desired contact time and method.
  1. Case Reference(*)
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  2. Describe your interest or concern
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  3. How best to contact?
  4. Please allow three to five business days for Dr. Rupe to be able to respond. Please indicate your "no later than" date with the calendar below. Cellphone numbers receive quickest response.
  5. Contact no later than(*)
    Please select a date when we should contact you.
  6. Best Time To Contact by Phone

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  7. Captcha Verification
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Roanoke Clinic, Roanoke Rapids, NC

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