Request an Appointment - New Patients Only

Request an Appointment - New Patients Only

Thank you for choosing OHC. If you a referring provider office, please go to the Refer a Patient Tab or click below:

If you are an existing patient, please go to the Contact Us Tab or click below:

*Fields with a red asterisk are required

Patient Information

Patient First Name*

Patient Last Name*

Patient DOB*

Patient Primary Phone #*

Phone

Patient Email*

Enter none if no email

Who Referred You to OHC? (If Known)

Your Preferred OHC Doctor (If Known)

Please click here to see list of doctors and their locations: https://ohcare.com/for-medical-professionals/locations-phone-fax/

First Available

Your Reason for Visit or Diagnosis

Service Requested*

Select

Patient Record Upload

For your convenience, you may upload a copy of your insurance card

Drag and drop files here or

How did you hear about us?

Select

Send me a copy of my responses

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