Request An Examination
Schedule an examination in our Madison Heights, Michigan medical offices.
Type of certification *
First Name *
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Last Name *
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Your Zip Code *
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Your Phone Number *
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Your Email Address *
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Do you have medical records documenting your condition? *
Do you have medical insurance? *
Requested Office Visit Date (Monday - Saturday) *
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Requested Office Visit Time (9-5 weekdays, 9-1 Saturday) *
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