Appointment Request

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Appointment Request Form

If this is an Emergency, do not contact us via email, please call 911. OR if your need is urgent, and you need to be seen within 24-48 hours, please call our office to schedule at 419.578.2020. Thank you.

Complete the following form:

  • Appointment requests are sent to your practitioner using regular email so please do not enter confidential information.

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