Please do not use this form if your need for a visit is urgent in nature. You will need to call 517-349-0027 to request an appointment.
Name:
*
Phone Number:
*
Email Address:
*
Type of Appointment Requested:
New Patient
Recheck
Retest
New Serum
Type of Insurance:
Blue Cross Blue Shield
Medicaid
Commercial
Other
Doctor Requested:
Dr. Kamal Mohan
Dr. Manoj Mohan
Dr. Hennessey
No Preference
Best Day of Week:
Monday
Tuesday
Wednesday
Thursday
Friday
No Preference
Morning or Afternoon:
Morning
Afternoon
No Preference
Reason for Visit:
Drug Allergy
Environmental Allergy
Food Allergy
Immune Deficiency
Latex Allergy
Stinging Insect Allergy
Code Number:
*
Enter Code Number
Please note: Okemos Allergy Center will schedule your appointment based on the submitted online scheduling request. You will receive an email within 72 hours of your confirmed appointment date and time, excluding holidays and weekends.
3955 Okemos Road Suite A1 | Okemos, Michigan 48864 (PHONE) 517.349.0027 (FAX) 517.349.5882
