This form is only for requesting Wellness for Life services, including well-woman exams, adult wellness exams and chronic disease management. We do not provide urgent care, treatment for sudden illnesses or injuries, or stand-alone work or school notes.
Requests are reviewed during normal business hours and should not be used for urgent medical needs. If you are experiencing a medical emergency, call 911 or go to the nearest emergency department.
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Requests are reviewed during normal business hours and should not be used for urgent medical needs. If you are experiencing a medical emergency, call 911 or go to the nearest emergency department.
English | Español