Online Appointment Request | Froedtert & MCW

Please review the following to help you get started:

This service is not for urgent or emergency situations. To make an urgent appointment, please call: 414-777-7700.
This form is for appointment requests only. Please complete as much information as possible.
Please provide adequate telephone information. A representative will call you within 1-3 business days to schedule your appointment.
Already a patient with MyChart? Save time by using MyChart to request an appointment with a provider you have seen within the last three years.

Are you the patient?

If you are not the patient, your name:

Patient Name

Patient Date of Birth

Patient Gender

Address

City/Town

State/Province

ZIP/Postal Code

Primary Phone Number

Secondary Phone Number

E-mail Address

Best Time to Contact You

8-10 a.m. (CST)

10 a.m.-Noon (CST)

Noon-2 p.m. (CST)

2-5 p.m. (CST)

Clinic or Provider or Specialty (if any)

Insurance Name/Type

Brief description of why you want to see the doctor

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Telehealth Virtual Visits

Meet face to face with your provider via MyChart on your mobile phone, tablet or desktop.