Contact Us Please complete the following information and we will contact you. Services: NCHC Appointment & Contact us Requests Select a Type of Request:(Required)Please select:New AppointmentCancel an AppointmentGeneral Contact usName(Required) First Last Address:(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone# for NCHC to Contact:(Required)Email:(Required) Enter Email Confirm Email Select a location:Please selectNCHC | 120 Connecticut Avenue, Norwalk, CT 06854NCHC at Smilow | 55 Chestnut Street, So. Norwalk, CT 06854Select a service:Please select:Adult MedicineBehavioral HealthDentalPediatricsPharmacyPodiatryTelePsychiatryWomen's HealthOtherInsurance Information:Please chooseYes, I have InsuranceNo, I am Self PayName of Medical Insurance: Policy #: Message to NCHC:Anything you would like our representatives to know before contacting you?Consent(Required) I agree to provide the information entered in this form to Norwalk Community Health Center.By submitting this form, I consent that the information provided is accurate and can be used by Norwalk Community Health Center (NCHC) to contact me. I understand that this is not an appointment confirmation, or appointment cancelation. Δ