Appointment - Pickaway County Public Health

Request an Appointment

Pickaway County Public Health

Please Note: Submitting this form is a request only and does not guarantee an appointment. A staff member will contact you to discuss availability and confirm scheduling. While walk-ins are welcome for many services, scheduling in advance or calling ahead is strongly encouraged to help minimize wait times and ensure staff availability.

Doctor Visit

Contact Information

Name

First Name

Last Name

Phone Number

Email address

Date of Birth (If Applicable)

Service Requested

Dropdown

Preferred Appointment Information

Preferred Date

Preferred Time

Alternative Date

Alternative Time

Additional Comments

I understand this is a request for an appointment only and does not guarantee an appointment on my preferred date or time.

I understand Pickaway County Public Health will contact me to confirm availability and finalize scheduling.

I understand this form should not be used for urgent or emergency medical concerns.

If you are human, leave this field blank.

Questions?
Phone: (740) 477-9667
Pickaway County Public Health
110 Island Road, Circleville, Ohio