MyChart| About Meriter | Contact Us | En Español

Request an Appointment

* Required Information

How to Request an Appointment MyChart Users
Please fill out the form below

If you don’t have a Meriter MyChart account and would like to request an appointment with a Meriter physician, please complete the form below.

Click Here if you allredy have a Meriter MyChart account

If you currently have a Meriter MyChart account, please click here to request an appointment.

This form is not for urgent health problems, same-day appointment, or appointment cancellations. Please allow 1 business day for a Meriter representative to contact you. For same-day appointments please call the clinic directly, and for medical emergencies please call 911.

Select a Preferred Doctor or Clinic:

Current Doctor:

[No Doctor Selected]
Please select a doctor from the right
Select by Clinic:
Select Clinic Select Doctor
Select by Specialty:
Select Specialty Select Doctor

Appointment Preference:

First Name: * Last Name: *
Date Of Birth:* Phone Number:*
Email Address: Alternate Phone:
Address Information: *
Address 1:
State: Zip:


Reason For Appointment:*