{"id":103,"date":"2021-02-06T22:23:46","date_gmt":"2021-02-06T22:23:46","guid":{"rendered":"https:\/\/www.brandywineuc.com\/?page_id=103"},"modified":"2021-03-18T20:52:25","modified_gmt":"2021-03-18T20:52:25","slug":"contact-us","status":"publish","type":"page","link":"https:\/\/www.brandywineuc.com\/your-visit\/contact-us\/","title":{"rendered":"Contact Us"},"content":{"rendered":"\n<p>Please fill in the form below and we will respond to you within 24 business hours. The more details you can provide, the more effectively we can assist you. We suggest you use the forms for billing, insurance, and non-urgent scheduling issues. This email option is not intended for any discussion related to medical issues. Also, many patient issues can be successfully addressed by logging into our <a href=\"https:\/\/16405-1.portal.athenahealth.com\/\" target=\"_blank\" rel=\"noreferrer noopener\">Patient Portal<\/a> here and selecting the appropriate option.<\/p>\n\n\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return 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Inquiry<\/option><option value='Clinical Inquiry' >Clinical Inquiry<\/option><option value='Schedule an Appointment' >Schedule an Appointment<\/option><option value='Other\/General Inquiry' >Other\/General Inquiry<\/option><\/select><\/div><\/li><li id=\"field_1_9\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_9\" >Please use this form instead:\n<a href=\"..\/request-an-appointment\/\">Request an Appointment.<\/a>, thank you.\n\nFOR MEDICAL EMERGENCIES PLEASE CALL 911 OR GO IMMEDIATELY TO YOUR CLOSEST HOSPITAL EMERGENCY DEPARTMENT OR URGENT CARE FACILITY.<\/li><li id=\"field_1_1\" class=\"gfield gfield--type-text gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_1\" ><label class='gfield_label gform-field-label' for='input_1_1'>First Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_1_1' type='text' value='' class='large'    placeholder='First Name' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_2\" class=\"gfield gfield--type-text gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_2\" ><label class='gfield_label gform-field-label' for='input_1_2'>Last Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_1_2' type='text' value='' class='large'    placeholder='Last Name' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_3\" class=\"gfield gfield--type-email gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_3\" ><label class='gfield_label gform-field-label' for='input_1_3'>Email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_1_3' type='email' value='' class='large'   placeholder='Email Address' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_4\" class=\"gfield gfield--type-email gf_right_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_4\" ><label class='gfield_label gform-field-label' for='input_1_4'>Confirm Email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_4' id='input_1_4' type='email' value='' class='large'   placeholder='Confirm Email Address' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_6\" class=\"gfield gfield--type-phone gf_left_half gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_6\" ><label class='gfield_label gform-field-label' for='input_1_6'>Phone:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_1_6' type='tel' value='' class='large'  placeholder='Phone Number' aria-required=\"true\" aria-invalid=\"false\"   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The more details you can provide, the more effectively we can assist you. We suggest you use the forms for billing, insurance, and non-urgent scheduling issues. This email option is not intended for any discussion related to medical issues. 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