Waukesha Family Practice Clinic is pleased to offer you an online appointment request service.
To request an appointment please agree to terms below and complete the form. We will process your request and confirm within 24 business hours. We will make every effort to schedule your appointment as requested.

This service is designed for non-emergency appointments. If you need immediate medical attention, please call 911 or visit the nearest emergency room.

For a same-day appointment, please call 262-542-5557
(Monday-Thursday, 7:30am – 5:00pm; Friday 7:30 – 12:00pm)

We value your privacy and will only use your personal information to schedule an appointment.

Terms of Use
I give permission for Waukesha Family Practice Clinic to use the information I supply on this form to fulfill my request for an appointment and to contact me by email if necessary using the email address I supply on the form.

I certify that I am at least 18 years old and I acknowledge that I have read and accept these terms and agree to use this form to request an appointment.

I understand that follow-up emails from Waukesha Family Practice Clinic will not be on a secure server.

In order for you to request an appointment electronically, you will need to provide confidential medical information. By proceeding through this notice and providing the requested demographic and medical information, you consent to the disclosure of such information to relevant Waukesha Family Practice Clinic staff. The information that you provide will be placed into our electronic database. Your specific information will be accessed and used only for scheduling purposes. Aggregate data (without patient identifiers) may be analyzed at a later date. The information that you provide will not be shared with other organizations, and cookies or other tracers will not be used to collect information or track your computer use. However, you should note that electronic mail and other Internet communications channels may not be secure against interception by non-authorized individuals. If you do not wish to transmit your medical information electronically, you should call Waukesha Family Practice Clinic at 262-542-5557 to request an appointment.