Angela Hardin Waitlist 
If you would like to become a patient of Angela Hardin, please complete this form and we will send you a confirmation email. The current wait time is 4-6 months. 
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Legal name (First and Last) *
Preferred Name  *
Phone number *
Email address *
Insurance carrier (if no insurance, please write 'cash-pay') *
Reason for establishing care (please provide a brief description so that we can determine if Dr. Hardin is the correct fit for you). *
How did you hear about Angela Hardin (who referred you)? *
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