New Patient Request Form

Carefully read through all instructions below:

FOR NEWBORNS - Call the office (do not complete this online request) if you have a newborn that needs to be seen post discharge or plan to delivery within 2 weeks. 

• Submit one form per patient.
• We will email you if we cannot take you on as a new patient, therefore a valid email address is required.
• DO NOT contact the office regarding the status of your request. 
• Average wait time from online application submission to being contacted by our office is several weeks.
• Our practice can only accept a very limited number of new patients. We do not have a waiting list. 
• Several of our physicians do not have available adult appointments for 3-6 months. 
• If you are in need of more urgent care, seek treatment at a walk-in clinic.  
• For help finding another PCP, contact Munson HealthLink at 231-935-5886 or via email at findadoctor@mhc.net