CALL FOR AN APPOINTMENT TODAY.

419-334-3869

Appointment Request

Error sending appointment request

Please call the office to schedule an appointment.

Sending appointment request

Thank you

Your appointment request has been sent. Please note this is only a request. No appointment will be made for you until a CHS receptionist contacts you to schedule the appointment.

Please complete the form below to request an appointment. Please note this is only a request. No appointment will be made for you until a CHS receptionist contacts you to schedule the appointment. 

This online appointment request may be used by established medical patients only. All dental and new patients must call the office.

Appointment Request Form

Person Requesting Appointment:
Patient Name:
Patient Date of Birth:
Patient Address:
Patient City:
Patient State:     Zip:
Patient Primary Phone:
Reason for Request:
Office Location:
Scheduling Preferences: Please select the appointment day and time that is best for you.
Day Time

All calls will be returned the next business day. We will make two attempts within the next business day to reach you at the phone number provided. If your appointment has not been confirmed, please contact our office during business hours at 419-334-3869.

 

Stay Connected