Online Appointment

IF THIS IS AN EMERGENCY, PLEASE DIAL 911 OR GO TO THE NEAREST EMERGENCY ROOM.
In order for you to request an appointment electronically, you will need to provide personal information. By proceeding through this notice and providing the requested information, you consent to the disclosure of such information to Avita Health System. The information that you provide will be placed into our electronic database. Your specific information will be accessed and used only for scheduling purposes. The information that you provide will not be shared with other organizations, and cookies or other tracers will not be used to collect information or track your computer use. However, you should note that electronic mail and other internet communication channels may not be secure against interception by non-authorized individuals. If you do not wish to transmit your medical information electronically, please call Avita Health System's Physician Referral line at 419-468-0961 to request an appointment.

Please allow 24 hours during the business week (Monday through Friday) for a response.
Requests made on Friday may not be responded to until Monday.
You must leave a valid phone number or we will not be able to contact you.

LAST NAME
FIRST NAME
DATE OF BIRTH
ADDRESS
CITY
STATE
ZIP
PHONE
	CHOOSE A MEDICAL PROVIDER BY SELECTING THE BOX NEXT TO THE PROVIDER'S NAME
	ALLERGY Eric Grimes, MD Lannette Clemons, PA-C EAR, NOSE & THROAT Eric Grimes, MD Lannette Clemons, PA-C FAMILY MEDICINE Julie Beard, MD John Hanna, MD, FAAFP Fereshte Khavari, MD Larry Leone, DO Mark Wood, DO Heather Auck, CNP Frank Millard, PA-C Jennifer Minton, CNP Kimberly Scott, CNP Trish Trubachik, CNP Erica Truka, CNP Holli Ujvari, CNP Rob Wisner, PA-C GENERAL SURGERY Eric Kuivinen, MD P. Stephen Novack, DO Daryl Sander, MD, FACS INFECTIOUS DISEASES Francis Blais, DO, FACOI INTERNAL MEDICINE Francis Blais, DO, FACOI James Goudy, II, MD Eric Haus, DO Elizabeth Klenk, MD Andrew Lee, MD Mihai-Liviu Ursachi NEPHROLOGY Jodi Dome, MD OBSTETRICS/GYNECOLOGY Eric Hoff, DO Bruce Kinney, MD, FACOG OPTOMETRY Terry Walker, OD, MS ORTHOPEDICS Robert Dawson, MD J. Jay Guth, MD James Kerbs, MD Lawrence Pabst, MD Thomas Zuesi, DO Laurie Cullen, PA-C PAIN MANAGEMENT Robert Gould, DO Ripal Parikh, DO PEDIATRICS Marcia Brown, MD Howard Ecksteain, MD Andrew Lee, MD PLASTIC & RECONSTRUCTIVE SURGERY Walter Bodjanac, DO PULMONARY MEDICINE James D. Heddleson, DO SPORTS MEDICINE J. Jay Guth, MD Thomas Zuesi, DO

Currently selected doctor: None