Appointment - Division of Human Genetics

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Division of Human Genetics : Department of Internal Medicine : College of Medicine : The Ohio State University
http://internalmedicine.osu.edu/cardiovascular//genetics/7308.cfm

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Appointment

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Please use this form to request an appointment with the clinic. To schedule by phone, please call (614) 293-6694 or toll-free 1-888-329-1654, Monday through Friday, 8am - 5pm EST.

Last name, First name and Daytime Phone are required.

Last Name:
First Name:
Daytime Phone:
Alternate Phone:
Reason for Referral?
Reason for Referral?	If other:
How did you hear about OSU Clinical Genetics?
How did you hear about OSU Clinical Genetics?	If other:
Comments:


*Department of Internal Medicine*	http://www.internalmedicine.osu.edu

The Ohio State University \| College of Medicine Department of Internal Medicine \| Division of Human Genetics 2001 Polaris Parkway \| Columbus, OH 43240 Ph: 614.293.6694 \| Toll-Free: 888.329.1654 \| Contact Us