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Dr. Mike Druschel's Waiting List
If you want to sign up for Dr. Mike's waiting list at Remedy Direct Primary Care, please submit this form and we will contact you once a slot becomes available. We expect to update things every 2-4 weeks.
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Email
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Your email
What is your first and last name?
*
Your answer
Are you the patient (if not, who is the patient)?
Yes
Other:
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What is your phone number?
*
Your answer
What is your date of birth (or the patient's date of birth)?
*
MM
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DD
/
YYYY
Please feel free to share any comments here about your medical desires and/or any special circumstances you want to communicate:
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