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.

Paperwork

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
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Are you an existing patient?

The easiest way to schedule or request an appointment is to log into your MyChart account or call your provider's office directly.

Don't have a MyChart account? Sign up today!

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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.

These requests are only monitored Monday-Friday during regular business hours. We do our best to respond to all patients in a timely manner. If you need immediate care, please visit one of our Urgent Care Centers or the Emergency Room.

All fields are required unless otherwise noted.

Are you a new or existing patient?
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Must be in 555-555-5555 format
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Please choose your preferred office.

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