Emory Clinic at Midtown Appointment Request Form

Please complete the form below. A representative from Emory Healthcare will contact you to schedule an appointment.**

**If your medical problem is an emergency, please seek immediate treatment by calling 911 or visiting your nearest emergency room.

*** Submitting this form gives Emory Healthcare the consent to send a survey to the email provided. The survey is sent in an effort to improve the patient experience for using the online schedule request tool.

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