Mobile Services Appointment Request

If you are experiencing a medical emergency, please contact 911.

For immediate crisis assistance:

  • In Howard County/Kokomo call 765-776-8555 or 888-204-6242.
  • Text IN to 741741.

For non-emergency appointment scheduling, please fill out the information below. Include a valid phone number* that you can be reached at.

  • *A return phone number is necessary to schedule an appointment; we cannot schedule through email for patient security.
  • If you are unable to provide a return call number, please contact us at 765-776-8555 during business hours. 

You may expect us to contact you within 1 business day to schedule an appointment. Thank you!

Note: We do not offer appointments for medication management only.


Patient Information

Patient Address

Contact Information

Please include a valid phone number that we can reach you at.
Note: A return phone number is required to make an appointment. If unable to provide a return call number, please contact us at 765-776-8555 during business hours at your earliest convenience. Thanks!