Appointment Request

• Established patients may use this form to request routine appointments.
• If you are a new patient or need a same-day appointment, please call our office at (989) 775-1610.
• If this is a life-threatening emergency, do not use this form. Instead, dial 911 or go to the nearest emergency room.

For your privacy, you will be asked to login to your MyMidMichigan Account or create an account if you don't already have one.

Appointment Request Form