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Allergy 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 (required)
Phone (required)
Date of Birth
Name of Insurance
Preferred Location
Are you currently a patient?
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Additional Information

Scott Bagenstose, MD
Mehmet Basaran, MD
Roger Friedman, MD
Megan Goebel, MD
Michael Goodman, MD
David Hauswirth, MD

icon phone(614) 827-0021

974 Bethel Road, Entrance C, Columbus, OH 43214

801 OhioHealth Blvd., Suite 220, Delaware, OH 43015

6670 Perimeter Drive, Suite 270, Dublin, OH 43016

1110 Beecher Crossing North, Suite C, Gahanna, OH 43230

Grove City
2526 London Groveport Road, Grove City, OH 43123

477 Cooper Road, Suite 480, Westerville, Ohio 43081