Request an Appointment

Appointment Request Form

If you are not a current patient and would like to request an appointment at our facility, please complete and submit the form below. If you are a current patient looking to schedule another appointment please call 810-630-1152. If this is an emergency please call 911 immediately.

DISCLAIMER: This form is not meant to contain any Protected Health Information (PHI).

Please visit our Pricing and Insurances page (at top of page) to make sure that our clinic accepts your insurance before submitting your request. Private pay options are available for those upon request.
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