Request a Physician Appointment Online

Main Line Health is dedicated to providing prompt and attentive service. Online appointment requests are handled by the Main Line Health Contact Center Monday through Friday, 8:00 am to 6:00 pm.

Please note: Due to high volume, current response time exceeds 48 hours. If your request is urgent, please call 1.866.CALL.MLH (225.5654). Thank you for your patience and understanding.

If you are having an emergency, call 911 immediately or go to the nearest emergency room.

If you have any questions please call 1.866.CALL.MLH (1.866.225.5654)

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The more info on the form, the faster the appointment can be arranged.

Please complete the form below. All fields are required to process your request (* - Denotes required field.)

Name (as shown on your insurance card)*

Title Mr Ms Mrs

First Name*

Last Name*

Gender*

Gender Male Female Unspecified

Date of Birth*

Phone number*

Email*

Address*

Address Line #1*

Address Line #2*

City*

State*

Zip Code*

Doctor you'd like to see*

Insurance Provider*

Member Id#*

Reason for Appointment*

When are you available for an appointment?*

What led you to our website?

Invalid field input or blank field detected. Please fill out the form above completely. All fields are required.

We're sorry, but our website encountered an error and we were unable to submit your appointment request at this time .

Please try again later or call 1.866.CALL.MLH (225.5654), Monday through Friday between 8:00 am–6:00 pm ET, to speak directly with one of our physician referral specialists, who can help you find the right doctor for your needs and assist in scheduling an appointment.

Once again, we apologize for not being able to complete your request at this time and thank you for choosing Main Line Health.

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Request a Physician Appointment Online

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