Request an Appointment

If this is an emergency, call:

NOTE: If you are NOT using insurance, please schedule here.

Existing clients can reschedule here.

Client Information

First name

Last name

Email address

Phone number

Date of Birth

State of Residence

We serve only Michigan residents

Insurance Plan

We ONLY accept: Blue Cross Blue Shield (no Blue Care Network) and McLaren (commercial only) **MEDICAID NOT ACCEPTED**

Insurance Member ID

Policy Holder's Name

Policy Holder's DOB

mm/dd/yyyy

Additional information

If there's anything else that you'd like us to know prior to your appointment, please include it here.

Your information will be encrypted.