ExistingPatientRegistration

Request An Appointment

Established Patient Only


Please note: We cannot process emergency requests through this form. If you are experiencing a medical emergency, please call 9-1-1.

This form cannot be used to schedule same-day appointments. For same-day appointments please call the office directly, for practice and provider numbers please visit our full directory listing.


Please complete the form below if you have been seen at Akron General in the last 3 years.

If you are a new patient or unsure, please complete the new patient form.

Patient refers to the person who will be seeing the medical professional.

Fields with an asterisk (*) are required
Requester Information
Basic Patient Information
Patient Contact Information
Appointment Details
Have you been a patient previously?