Northern Michigan Medicine and Pediatrics

New Patient Request Form

  • Submit one form per patient (incomplete forms cannot be processed).
  • Our practice can only accept a limited number of new patients.
  • Due to the extremely high volume of requests, you will only be contacted if accepted as a patient, and our goal is to contact you within 10 business days. Please DO NOT contact the office regarding the status of your request. 
  • Current wait time for new patient appointments with some physicians can be as long as 8 weeks (with the exception of new babies). If you are in need of more urgent care, seek treatment at a walk-in clinic.  
  • For help finding a PCP, contact Munson HealthLink at 231-935-5886 or via email at


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(Include any previous last names)

(if no insurance, enter "cash pay")


Contact Us

Main:  231-935-0614

Fax:  231-935-0832

Patient Portal

We accept:


Contact our office to verify
accepted insurance plans and
additional payment options

Northern Michigan Medicine and Pediatrics

3643 West Front Street , Ste. C
Traverse City, MI   49684

Phone: 231-935-0614
Fax: 231-935-0832