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Schedule an Appointment

This form can be used to request an appointment at Capitol Square Healthcare for state employees, covered spouses and covered children ages 2 and older. A representative will respond to your request promptly. 

For immediate assistance, please call Capitol Square Healthcare toll free at 1-844-342-1791. Same-day appointments may be available. If you are experiencing a medical emergency, please call 911.

 

First name  *Last name  *Email  *Date of Birth (mm/dd/yyyy)  *Phone (xxx-xxx-xxxx)  *Please describe the reason for your visit