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Appointment Request

Appointment Request
* Required Fields

This form is for non-emergency situations only. If you have an immediate health concern please call
Mercy On Call at 319-358-2767 or 1-800-358-2767.

Want to make an appointment for a mammogram screening? Please use our Mammogram Appointment Request Form.
 
Doctor You Want to See   Select a Specialty
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- OR -
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Do You Currently Have a Primary Care Doctor?*
 
 
 
 
Preferred Time of Day for Your Appointment*
1st choice   2nd choice
select
select
 
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select
 
(We'll make every effort to give you an appointment close to the time you select.)
 
 
Preferred Day of the Week
1st choice 2nd choice
select
select
 
 
Briefly Describe Your Symptoms or Reason for Doctor Visit

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Mercy Iowa City, 500 East Market Street, Iowa City, IA 52245 | Accredited by The Joint Commission

319-339-0300 or 800-MERCYIC (637-2942)

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