REQUEST AN APPOINTMENT

Walk-In Clinic Patients should use Next In Line for an appointment.

Also, an appointment is not necessary if your doctor has only requested lab work.

I am a new patient:
Requested Provider or Center of Care:

Name:
Phone:
Email:
Insurance:
Date of Birth:

Please note: We cannot process an emergency request through this form. If you are experiencing a medical emergency, please call 911. After requests are received by Grace Health System, a representative will contact you within 2 business days to help you schedule an appointment.