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Sleep Division Online
Appointment Request

Please complete this form to submit your appointment request. The information is submitted securely to our office.

We respond to all requests within 48 hours but strive to respond within 24 hours. Do not submit this form for medical emergencies. For emergencies please dial 911 or immediately contact your medical provider by phone.

Name
Email
Phone
Date of Birth
Name of Insurance
Are you currently a patient?
Yes     No   (required)

Additional Information
 

To provide better access for our patients, we have extended hours in our centralized scheduling department. Our new hours are: M-F 8am-5pm.

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Samuel Dzodzomenyo, MD
John Eickholt, MD
Rebecca Snader, MSN, NP-C

Columbus
974 Bethel Road, Entrance E, Columbus, OH 43214
7811 Flint Road, Suite C, Columbus, Ohio 43235
 
Delaware
801 OhioHealth Blvd., Suite 220, Delaware, OH 43015
 
Dublin
6670 Perimeter Drive, Suite 120, Dublin, OH 43016
 
Westerville
477 Cooper Road, Suite 480, Westerville, OH 43081