Chelsea Internal Medicine

Michigan Hypertension Center

Personal Adult Care with Academic Excellence

 

Appointment Requests

This is to request non-emergent appointments.  This does not actually make your appointment.  You should never use this for any potentially emergent or urgent requests.  Please call (734) 475-8677 if you have any potential urgent requests.  For emergencies, please call (734) 475-8677 (including after-hours) or 911

Your first name:

Your last name:

Birthdate (mo/day/year)19

Your email address

Telephone Number to reach you

Reason for visit

Healthcare provider you wish to see

Urgency Preference

Day Preference

Time Preference

Other Request

 

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Last modified: 03/09/06.