This form is intended for employers looking to engage with Middlesex Health's Occupational and Environmental Health service. If you are a patient looking to make an appointment, please call us at 860-358-2750.
Please note: We cannot process emergency requests from this form. If you are having a medical emergency, please call 911.
When you submit this form, your information will be sent to the appropriate Middlesex Health staff, who will help you schedule an appointment or complete your request.
All fields are required unless otherwise noted.