Request an Appointment
Ready to become a new patient?
Use the form below to request an appointment with a specific provider or office. You can also call 860-358-4808 to speak with a member of our team.
Filling out paperwork before you come to the office helps us make the most of your visit! Please use the links below to download the appropriate paperwork.
For New Patients
For All Patients
Are you an existing patient?
Don't have a MyChart account? Sign up today!
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.