Appointment Request

Main Line: 216-535-9100 | Appointments: 216-535-9100 | Fax: 216-535-2626

Fill out the form to request an appointment

Important Note About This Form: Submitting this form does not schedule an appointment. It simply begins the process. Once we receive your request, a member of our Patient Support team will contact you to confirm details and guide you through next steps.

This may include:

  • Verifying your preferred location and provider
  • Sharing available appointment dates and times
  • Reviewing insurance or sliding-fee eligibility
  • Providing any forms or documents you’ll need before your visit
  • Answering questions about transportation, translation services, or telehealth options

For urgent medical concerns, please call 216-535-9100 during business hours or if it’s an emergency dial 911.

Appointment Form