Park Internal Medicine

S c h e d u l e a n A p p o i n t m e n t

Here, you can request an appointment with Park Internal Medicine physicians who practice at Novi and Brighton locations.

Please note that this function is not for urgent appointments or for appointments you may need today. If this is an emergency, call 911 or go to your local emergency room.

Appointment requests usually are processed within two business days.

(Because we work in health care, we value your privacy and confidentiality. Your personal information will not be used by us other than to schedule an appointment. We will never lend or sell your name to another company.)

After completing the information, a member of our staff will contact you via phone to confirm your appointment and give you any other specifics.

* required

*First Name:
*Last Name:
*City:
*State:
*Zip:
*Daytime Phone Number:
Alternate Phone Number:
Best Time To Reach You:	From To
*Date of Birth:		Enter mm/dd/yy
Your Name:		(If you are making this appointment for someone other than yourself.)
Doctor You Want To See:
Location Preferred:
Preferred Time of Day For Your Appointment:	1st Choice: 2nd Choice:	(We will make every effort to give you an appointment close to the time you select.)
Preferred Day of The Week:	1st Choice: 2nd Choice:
Or Tell Us What Specific Days Work for You:
Reason For Appointment:		(Please be as specific as possible.)
Briefly Describe Your Symptoms:
Insurance:		(Tell us what insurance plan you are covered by.)
Tell Us Who Told You About Park Internal Medicine:
Note: (If you're not sure which numbers or information to provide us about your insurance plan or are unsure whether your plan covers certain services, please call us at (248) 465-4163

After completing the information, a member of our staff will contact you via phone to confirm your appointment and give you any other specifics.

Thank you for choosing Park Internal Medicine.