Request an Appointment Have you ever received services at Lucas County Health Center?YesNoUnder what name were you treated? First Middle Last Patient InformationName* First Middle Last Birth Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Alternate PhoneEmail* Insurance InformationDo you have insurance?*YesNoName of Plan Appointment Request InformationProvider*Select a ProviderKenneth Anderson, DOChristine Buttell, PA-CPaul Conte, MD, FACS (Surgery)Greg Cohen, DOMiranda Gebhart, ARNPAbby Hamilton, ARNPPeter Hoftiezer, DOAllison Krutsinger, PA-CDale Lensing, MD (Gynecology)Phillip Masters, Pharmacist (Clinical Pharmacy)Giselle Mery, MD (Oncology)Eric Muhm, DPM (Podiatry)Jessica Ogden, ARNP (RheumatologyChris Osier, PA-CAmy Poncelow, PA-CSharon Squibb, MS, CNM, ARNP, NCMPPhilip Sundquist, MD (Wound Care)Kayla Wallace, ARNPReason for Appointment Appointment Time Preferences Please note: This request does not ensure appointments will be available during your requested date/time. If you need an immediate appointment, please call us at (641) 774-8103.Date* MM slash DD slash YYYY Time* Morning Afternoon Please select another day and time below, in case the requested appointment time above is not available.Secondary Date MM slash DD slash YYYY Time Morning Afternoon