Right to a Good Faith Estimate

You may have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Learn More

Request an Appointment

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.

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