Northern Michigan Medicine and Pediatrics

New Patient Request Form

  • Please read through all the information below.
  • Submit one form per patient.
  • Our practice is only accepting a limited number of new patients.
    • We will email you if we cannot take you on as a new patient, however, due to the high volume of requests we are sometimes not able to reply to everyone.
  • If you do not hear back from us within 15 business days, we are unable to take you on as a patient.
  • 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 12 weeks, with the exception of new babies. Call the office if you have a new born that needs to be seen post discharge. 
  • 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

 

* = required

(Include any previous last names)

(if no insurance, enter "cash pay")

 

Contact Us

Main:  231-935-0614

Fax:  231-935-0832

Patient Portal

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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