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Appointment Request
 
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To schedule an appointment you may call our office at (248) 557-5461 or complete the appointment request form below. We will then contact you within one business day to reserve and confirm your appointment.

If this is an emergency, or if you are trying to cancel or change an existing appointment, please do not use this form. Contact us by phone at (248) 557-5461.

First name:

Last name:

Address:

City:

State/Province:

Zip/Postal Code:

Phone:

E-mail:

Preferred Dates:

Preferred Times:

Please describe your symptoms: