Request An Appointment

First name

Last name

Phone

Birthday

Month

Day

Year

This information is for insurance and care purposes.

Multi-line address

Country/Region

Address

City

Zip / Postal code

Will you let us know why you need to see the doctor?

This field is not required, but it may help us in ensuring the doctor is able to provide as much time as you deserve when we schedule your appointment.

Please upload a copy of your insurance card, front and back.

These can be added as images or as a document with all information typed out. Up to two attachments may be uploaded at one time.

What date and time would you like to see the doctor?

Month

Day

Year

Time

HoursMinutes

If you need an appointment sooner than three hours from filling out this form, please call our office directly at 337-738-2713 and we would be glad to assist you.

Which provider would you like to see?

First available

Dakota Johnson, MD

Alex Courville, MD

Jacqueline Melancon, FNP

How do you prefer we contact you to set up your appointment?

Phone Call

Text Message

The Kinder Clinic uses a request appointment form, rather than an online scheduling tool, to better serve you. We believe patients deserve more than short, standard appointment windows that leave them feeling rushed. Fill out the form below, and our staff will contact you to set up an appointment that works for you.