Give Thanks

Create grateful hearts with a Family Thankful Jar

When we are consumed by the everyday hustle, it’s hard to stop and express gratitude to and for those around us. Thanksgiving presents the perfect opportunity to do just that. As the holiday approaches, consider making a family thankful jar to give everyone a chance to express what they are thankful for every day.

Here’s how you can make your own Family Thankful Jar:  

  1. Grab a jar, plastic container or old Easter basket. If they are up for it, have the kids decorate the jar.
  2. Cut up strips of paper & place near the jar with a pen
  3. Encourage the family to jot down a daily gratitude. If you have guests coming to dinner, have them add a note to the jar too!

Once Thanksgiving dinner is done, sit down together, open the jar and read through the notes of gratitude. Taking the time to appreciate each other can have an amazing impact on family dynamics. Thanksgiving is a reason to get started but continue to model and encourage gratitude all year long. Make opening your gratitude jar a monthly event, or have everyone express one gratitude at the end of each day.


IHA Urgent Care locations are open on Thanksgiving! Don’t spend your holiday waiting in a waiting room. Save your spot in line at an Urgent Care location near you, and wait at home.

Take 2: Type 2 Diabetes

Take a proactive approach to preventing Type 2 Diabetes.

Author: Tendai Thomas, MD, FACP

Diabetes is a chronic disease that affects one in ten Americans today. Diabetes occurs when your blood sugar levels are too high. In normal circumstances, your pancreas is able to produce a hormone called insulin which regulates and maintains normal blood sugar levels. However, with diabetes, this process breaks down, causing blood sugar levels to rise to concerning levels. Diabetics have problems with high blood sugars due to a lack of insulin, or because their body does not know how to use insulin well.  It is important to either avoid developing diabetes or keep your diabetes well controlled because diabetes increases your risk for several other conditions including heart attacks, stroke, kidney disease, vision loss, nerve damage, and circulation problems.

There are two main types of diabetes. Type 1 diabetes often occurs in young individuals when the immune system attacks and destroys cells in the pancreas that make insulin. Subsequently, Type 1 diabetics need to take insulin every day to stay alive. Type 2 diabetes, which is much more common, tends to occur at an older age. Ninety percent of people with Type 2 diabetes are overweight or obese. These individuals produce insulin from the pancreas, but it is not used effectively to regulate blood sugar levels.

The top 7 risk factors for Type 2 diabetes include:

  1. Obesity
  2. Sedentary lifestyle (lack of physical activity or exercise)
  3. Unhealthy eating habits
  4. A family history of diabetes
  5. Increased age
  6. Hypertension and high cholesterol
  7. Diabetes during pregnancy

If you are at risk for developing Type 2 Diabetes, there are some steps you can take to delay or even prevent the diagnosis.

Start by knowing your risk level. Take this quiz from the American Diabetes Association to find out where you stand: https://www.diabetes.org/risk-test

Lose weight and keep it off. Maintaining a healthy weight is an important factor preventing diabetes. Losing 5% – 10% of your body weight can make a big difference in reducing your risk of getting the disease. Once you achieve your weight loss goals, work to keep the weight off. 

Stick to a healthy eating plan. Reducing your daily calorie, carbohydrate and sugar intake is key to weight loss. Consume smaller portions at every meal, eat less processed and simple sugar filled foods, and avoid drinks high in sugar. Remember your food groups when meal planning for the week. A healthy diet includes a variety of foods from every group!

Exercise 5 days a week. Exercise provides many benefits to your health. Make a goal to get 30 minutes of exercise 5 days a week. You can also consider obtaining an exercise partner to help keep you focused and on target. If exercise hasn’t been a part of your routine, talk to your physician for ideas to start slowly and work towards your goal.  

Don’t smoke. Smoking can contribute to insulin resistance and many other health conditions related to diabetes. If you do smoke, please talk with your doctor about different approaches you can take that will help you quit.

Go at your own pace. When we make major changes to our diet or activity level, it’s easy to get frustrated along the way. Go slowly and create goals that are realistic for you and your body. Start with small steps and small changes and work your way up! 

Keep your physician in the loop. Make an appointment to discuss your concerns with your primary care physician. They will help determine what else you can do to reduce your risk for Diabetes, and if you have already been diagnosed, they can help prescribe and manage any medications necessary to keep you feeling your best!

If you have already been diagnosed with Type 2 Diabetes, there are several treatments for managing your diabetes. For all individuals, nutrition is the key element for managing diabetes. In addition, since most people diagnosed with Type 2 diabetes are overweight, lifestyle changes that include regular exercise and weight loss are extremely important. Other therapies include the use of oral medications, injectables, and insulin administration. Talk to your primary care physician to find the best treatment for you.

Make An Appointment

Winterize Your Skin

Cracking down on dry hands.

Winter is just around the corner, and with it come fun winter sports, cozy sweaters, and a great excuse to stay inside and watch a movie. The not-so-fun side of winter includes dry and cracked skin on your hands.  The skin on your hands is thinner and has few oil glands than the rest of your body, so we’ve got some tips to help you be extra kind to your hands during the winter months.

  1. Dust off the humidifier. When the heat comes on, the skin dries out. To help replace some of the moisture in the air, pull the humidifier out of the closet and fill ‘er up!
  2. A lot of moisturizer. We wash our hands more in the winter months to avoid illnesses, and that coupled with the cold weather is hard on your skin. To avoid cracked skin on your hands, keep bottle of moisturizer on your sink, and apply lotion every time you wash your hands. Keep another tube of moisturizer in your car or with you in a work bag or purse and apply several times a day.
  3. Bundle up! Whether you prefer gloves or mittens, get a pair that you will wear, and protect the  skin on your hands from harsh temperatures and cold surfaces.
  4. Avoid super hot water. There are few things more comforting than a hot shower after being out in the cold, but super hot water actually dehydrates your skin. Keep your shower temperature on the warm side and buy a fancy pair of rubber gloves for doing the dishes.
  5. Know when to seek help. If you are diligent about skincare, but you can’t seem to stop the peeling or cracking, it may be time to see a professional. Persistent dryness could be a sign of a health condition like eczema, psoriasis or even an allergic reaction. Sometimes store-bought moisturizers won’t do the trick, so you may need to take a different approach to treating your dry skin.

It’s easy to schedule an appointment with your provider – simply visit our online appointment tool, scroll to find your provider, and click to schedule an appointment at a time that works for your family!

Make An Appointment

Fall Back (without falling apart)

Helping your child adjust to the time change

Even though we gain an hour in the fall time change, it can have an impact on sleep schedules for parents and children alike.  The sleep periods don’t move, but the time does. So, a child that normally sleeps from 8:00 pm to 6:00 am, will now come bouncing out of their room at 5:00 am. Ouch. What can you do to help your child (and yourself) adjust to daylight savings time? Start with these 4 steps:

  1. Adjust schedules.

Put your child to bed a half hour later than usual, to prepare for falling back an hour. For a teenager, time changes can be especially difficult. Encourage them to stick to their original schedule and get to be an hour earlier than the clock reads (at their original time). Also, clear your schedule the day after a time change to make the transition a little easier on everyone in your house.

2. Get ready to get up!

You know your little ones are going to be ready to roll an hour earlier than usual. Do yourself a favor, and get to sleep at your normal bedtime, so you are ready to roll when they are (or as ready as possible).

3. Be patient.

Gaining an hour is much easier than losing one, but we still feel a stress on our minds and bodies. Be patient with yourself and your kids.

4. Routines rule!

Kids do well with routines, especially when things are changing around them. Keep consistent and stick with your typical routine to help them adjust mentally and physically to their new schedule.

If you have concerns about your child’s sleep schedule, don’t lose sleep! Reach out to your pediatrician or pediatric provider for some help.

It’s easy to schedule an appointment with your pediatric provider – simply visit our online appointment tool, scroll to find your pediatric provider, and click to schedule an appointment at a time that works for your family!

Make An Appointment

Halloween Safety

Starting November 1st every year, most children begin their countdown to the next Halloween. And why wouldn’t they? Costumes! Candy! Late bedtimes! While there’s so much fun to be had, there are also safety concerns. Read on for safety reminders to ensure your Halloween night is delightful, not frightful.

  • Trick-or-treat in groups or individually with a trusted adult.
  • Be sure drivers can see you walking or crossing the street, Wear glow sticks or add some reflective tape to the costume.
  • Bring a flashlight along, so you can see where you’re going and avoid falling.
  • Walk. Don’t run.
  • Look both ways when crossing the street and use crosswalks when possible.
  • If you’re driving, go slow and keep your eyes open for trick-or-treaters.
  • An adult should look over the candy haul before anyone digs in. Factory wrapped treats are the safest. Homemade treats from strangers are not safe. Pay close attention to any ingredients that may trigger an allergic reaction.
  • Approach well-lit homes only, and never enter a stranger’s home.
  • Do not accept a ride from stranger. Ever.
  • If heading out in a group, plan the route ahead of time, and share it with a trusted adult.
  • Pumpkins are hard to carve, even for adults. Use a knife with a rounded tip and be sure a grown-up does the carving or oversees the activity.  
  • Use caution if candles are part of your décor. Look for fire-resistant costumes and place open flames in a safe spot (away from little hands, claws, paws…) Battery operated, or LED candles are the safest choice.
  • Accessories can make or break the costume. Be sure they are short, soft and flexible.
  • If makeup or face paint is part of you or your child’s costume, test it on a small part of your skin, especially if you have sensitive skin, before applying it on Halloween night.

If you’re faced with a Halloween boo boo or illness, don’t go batty. IHA Urgent Care locations are open late and are ready to treat you and your pumpkins.

Wait in line at home, click below to save your spot in an IHA Urgent Care close to you.

Save Your Spot

Flu Shot FAQs

What are the benefits of the flu vaccination?

Receiving the flu vaccines reduces flu illnesses, sick appointments or hospital stays, and missed time from work or school. It can also be life-saving for high risk patients like children or seniors.

Can the flu vaccine give me the flu?

The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. However, you may experience some minor side effects like, soreness, redness or swelling at the shot site, a low grade fever, and some aches.

For those that receive the nasal spray, the viruses are weakened and do not cause severe symptoms often associated with influenza illness. Side effects from the nasal spray may include, runny nose, sore throat, cough, wheezing, headache, vomiting, muscle aches, or fever.

Who should get vaccinated this season?

Everyone six months of age and older should receive a flu vaccine at the beginning of the flu season, typically every fall.

Who should not be vaccinated against seasonal flu?

A patients age, health or allergies may determine they should not receive the flu vaccine. Talk with your physician to ensure you or your children should receive the flu vaccine.

Why should I get my child vaccinated?

The flu is dangerous for all people, but children under five years old are at an especially high risk when they get sick with the seasonal flu. The flu vaccine is your and your children’s best defense against contracted and spreading the flu.

When should I get a flu vaccine?

For people receiving one dose of the flu vaccine, the Centers for Disease Control recommends that people get the flu vaccine by the end of October. If your child requires two doses, they will need to be given four weeks apart, so chat with your pediatrician on the best time to give the first dose. Getting the vaccine in the summer months may result is reduced protection later in the flu season, especially for high risk patients.  There are benefits to receiving the flu vaccine later in the season, so it’s never too late to be vaccinated!

How effective is the flu vaccine?

The patient’s age and health status will determine the effectiveness of the flu vaccine, as well as how well the flu in the vaccine matches the flu circulating in your community. The CDC estimates that the flu vaccine reduces the risk of flu illness by between 40% and 60% among the overall population, when the seasonal flu circulating is well-matched with the flu vaccine. 

Besides vaccination, how can people protect themselves against the flu?

Getting the flu vaccine every year is your best defense against the flu. People should also take preventive actions every day. These include, frequently washing hands, covering coughs using the inside of your elbow, not your hand, and avoid having contact with people who are sick (even if they haven’t been diagnosed with the flu).

Where can I get the flu vaccine?

This year’s flu shot is available at IHA Primary Care practices and pediatric doses are available at IHA Pediatric practices. Adults and children may receive the flu shot at any IHA Urgent Care location. Click below to schedule your flu shot.

Schedule Your Flu Shot

6 Tips to Prevent Mosquito Bites & Viruses

Don’t let the cooler weather fool you, mosquito season is not over. More than a pest, these buzzing insects can carry and spread dangerous diseases to both humans and animals. Here in Michigan, health officials are advising residents to take precautions after several residents became infected with the mosquito-borne virus, Eastern Equine Encephalitis (EEE). The only way to prevent mosquito-borne illnesses is to avoid being bitten by them.

Until the nighttime temperatures consistently fall below freezing, The Michigan Department of Health and Human Services has issued the following recommendations to protect yourself and your family against mosquito bites:

  1. Avoid being outdoors at dusk and dawn when mosquitoes are most active
  2. Wear light-colored, long-sleeved shirts and long pants when outdoors
  3. Apply insect repellents that contain the active ingredient DEET or other EPA- approved product to exposed skin or clothing, always following the manufacturer’s directions for use
  4. Use nets and/or fans over outdoor eating areas
  5. Maintain window and door screening to help keep mosquitoes out of buildings
  6. Empty water from mosquito breeding sites such as buckets, unused kiddie pools, old tires or similar sites where mosquitoes lay eggs
    For those that work outdoors or cannot avoid being outdoors at dusk or dawn, be diligent about using insect repellent, and cover as much of your skin as possible.

If you’re concerned about or experiencing symptoms from a mosquito bite, reach out to your primary care physician: Make An Appointment

Or visit an Urgent Care location near you: Save Your Spot

Read the press release from the Michigan Department of Health and Human Services: Michigan.gov/emergingdiseases

Frequently Asked Questions about Eastern Equine Encephalitis from the Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/easternequineencephalitis/gen/qa.html

Work + Life: The Juggle is Real

Finding a balance between work and life is one thing. Throw school in there, sports team practice, a science fair project, a growth spurt that requires new shoes that are only available at the store across town, and you have a perfect recipe for physical and mental burnout. Burnout can leave you feeling exhausted, drained, or even physically ill. You can’t always eliminate the stress from a busy schedule or workday, but you can learn to manage it.

Start by asking yourself: What needs to be done? Look at your task list and separate what truly must be done from less critical tasks. Things like work tasks, school events and appointments are not negotiable, while others may be. Sort through your to-do list and eliminate low-priority tasks where you can.

Create a shared family calendar. Whether you like a paper calendar stuck to the fridge, or you’re a digital family, there are templates and tools for everyone. Get upcoming events listed in one place, so everyone knows where they are supposed to be.


Wherever you are, be there. “Be present” is a trendy phrase that we hear a lot these days. But, it’s hard not to look at the 5 notifications that just popped up on your phone. When possible, set your device aside and focus your attention on what is happening around you. Maybe it’s dedicated time to play with your child or have a conversation with your spouse or a good friend. Making a conscious effort to focus on one task or person at a time will help clear the clouds of stress.


Make time for your family.
So many evenings are spent rushing to practices, classes or events, and dinners are consumed during the car ride. Try to find time each week to eat together as a family. Institute a family game night, a bike ride, or maybe a family meeting. Find ways that your family can be together enjoying each other without interruption or distraction (see point above). Ultimately those closest to you will be your front lines of support, so a weekly check-in will help catch when anyone is starting to succumb to stress.


Make time for yourself. The best way to work time for yourself into your schedule? Schedule it! Be creative (Paint! Garden! Journal!), eat a healthy diet avoiding sugar, caffeine, and carbs, have dinner with friends. Think about what truly brings joy into your life and make time for it.
Feel the burn! (Not the burnout). Exercise is one of the best ways to eliminate stress. That doesn’t mean you have to make it to a 5 AM barre class. A 10-minute walk can boost your mood and outlook for 2 hours! Find ways to work exercise into your daily routine, even if it means stretching on the sidelines at soccer practice.


Know when it’s time to ask for help. Burnout can happen at home or at work. Learn to recognize when stress is taking over, and you need help. Then ask for it. Burnout isn’t one size fits all. It can look and feel different for everyone. You may start to feel exhausted, moody or withdrawn. You may not remember what you had for lunch or where you are going when you leave the house. You may start to notice muscle pain from clenching or grinding your teeth.
If you are feeling the symptoms of burnout, seek support from those around you before you reach your breaking point. We’re here to help, too. Reach out to your primary care provider, they will help you extinguish burnout and feel like yourself again.

It’s easy to schedule an appointment with your primary care provider – simply visit our online appointment tool, scroll to find your provider, and click to schedule an appointment at a time that works for you!

Make An Appointment

Sun Safety: Protection is key for fun in the sun

Fifteen minutes. According to the Center for Disease Control, that’s all it takes for the sun’s ultraviolet (UV) rays to damage your skin. When you’re on beach or pool time, 15 minutes goes by quickly. It feels great to soak up those rays, but they are harming your skin and are putting you at risk for long-term skin damage and worse, skin cancer. Before you head out into the sun for the day, take some time and precautions to keep yourself and your family safe all summer long, and you’ll be golden for some fun in the sun!

Use Sunscreen

It’s one of the easiest ways to prevent skin cancer. Look for a sunscreen with broad spectrum protection against both UVA and UVB, an SPF of at least 30, and water resistant. When applying sunscreen, more is more. You want to be sure to get a thick layer of sunscreen on your skin in order for the SPF to do its job. For an average size person, remember the teaspoon rule, and adjust for all ages and body types:1 teaspoon to the face/neck/scalp1 teaspoon for each arm1 teaspoon to the chest and abdomen1 teaspoon to the back2 teaspoons for each leg

Sunblock lotions are the preferred choice, but if you are using a spray sunscreen, apply outside by holding the bottle close to the skin and spray on each area for approximately 6 seconds, or until the sunscreen is visible on the skin (typically, when it looks white). Then, rub it in. Don’t apply spray sunscreen directly to the face. Instead, spray generously into your hand and apply to your face as you would a lotion. Don’t forget to apply a lip balm with an SPF of 30, too!

Sunscreen will wear off throughout the day. Be sure to reapply every two hours and following exposure to water or sweat.

If you’re avoiding sunscreen because you don’t like how it feels on your skin or you had an allergic reaction, try another type or brand. There are a variety of choices by a variety of brands, so if you aren’t happy with one, try another until you find one that works with your skin. You may want to make an appointment with your primary care provider or dermatologist to discuss your individual needs. After all, the best sunscreen is the one you will wear!

Avoid exposure between 10 am and 4 pm

Have you heard of the shadow rule? If your shadow is shorten than you are in real life, the sun’s rays are strong. During this time, you should avoid exposure or follow precautions to protect yourself and your family. For our region in the Midwest, the sun is most intense from 10:00 a.m. to 4:00 p.m., so you’ll want to be the most vigilante in protecting your skin during this time.

Use Sunglasses

Your eyes will absorb those harmful rays much like your skin does. Look for sunglasses that block and absorb UVA and UVB light. The lenses should fit close to the skin and be large enough to cover your eyes and the surrounding areas. The bigger the better! Polarized lenses will help eliminate glare, which is great for driving or days in the water or snow.

Drink more water

When you’re sweating, you are losing water. Drink plenty of water throughout the day, especially in hot weather to keep dehydration at bay. Don’t wait until you feel thirsty. Also, look for signs of heat exhaustion such as; feeling overheated, tired or weak. Nausea, headaches and dizziness are also indications that it’s time to get out of the sun, cool down and drink some water. Heat stroke is a more serious condition. If you or someone in your family stops sweating, has red and/or hot skin, a high temperature, confusion or is suddenly uncoordinated, seek medical attention right away.

Go Long!: Wear Protective Clothing

Long-sleeved shirts and long pants provide an extra layer of protection while spending time out in the sun. Look for clothing made with tightly woven fabrics. Those linen pants aren’t going to protect you from the sun, so be sure to wear sunscreen underneath. When playing the water, look for bathing suits that feature a sun shirt, especially for little ones.

Hats Off ON!: Wear a Broad Rimmed hat

Wearing a hat with a full brim is a great way to protect the scalp, ears, face and neck from exposure to the sun’s UV rays. Tightly woven fabric is the key to a good hat, straw hats are cute, but don’t provide the protection you need. When purchasing sun hats for the family, be sure to pick the correct sizes for each person. Kids will pull off a hat that slips down over their eyes.Seek the shade & avoid direct sunlight

Trees or shelters block the sun’s UV rays and provide ultimate protection. Seek out these spaces when spending time outdoors to help protect yourself and your family from painful sunburns and help reduce the risk of skin cancer. When you can’t find shade, make it! Invest in a beach umbrella or tent to shield your family from the sunlight.

Be cautious of reflections

Your exposure to the sun’s rays increases when the sun shines onto and reflects off of bright surfaces, like water, sand or house paint, for example. When spending time near a reflective surface, ensure everyone is sporting sunglasses and sunscreen or protective clothing are being used consistently.

Tanning

Don’t. Tan skin is damaged skin and the impact can last or even shorten a lifetime. Tanning should not be part of a beauty regiment at any point in a person’s life.

Protection 365 Days

Skin cancer prevention is not seasonal. Sure, we wear less clothing and spend more time outside in the sun’s rays during the summer months, but protection from those rays is just as important during the winter months. UV rays reflect off snow just as they do off of sand, water and concrete. Apply sunscreen to the face and any other exposed skin, wear sunglasses and lip balm every day. When it comes to sun safety, there’s a lot of information to soak in. Download this handy checklist and keep it in your beach bag to help ensure you and your family are covered for summer skin protection.

Sun Safety Checklist

For questions concerning dangers to your skin from the sun, consult with your dermatologist.

It’s easy to schedule an appointment with your dermatology provider – simply visit our online appointment tool, scroll to find your dermatology provider, and click to schedule an appointment at a time that works for your family!

It’s easy to schedule an appointment with your provider – simply visit our online appointment tool, scroll to find your provider, and click to schedule an appointment at a time that works for your family!

Make An Appointment

On your mark, get set, go! Summer Health and Fitness: Family Style

Family Fitness Fun

Physical fitness is truly a family affair – it’s good for every body! For people of all ages, physical activity is one of the most important parts of a healthy lifestyle. It’s recommended by the U.S. Department of Health and Human Services that adults have at least 150 – 300 minutes of moderate physical activity per week and children at least 60 minutes per day. Working another 30 – 60 minutes into already packed schedules is not easy, so it has to be fun, or let’s face it – we’re not doing it. We put our heads together and came up with some ideas for summer fun that make getting active as a family no sweat.

Make a splash!

Pool, sprinklers, water balloons, slip and slide, a car wash, or just the hose: you really can’t go wrong with any water-based activity. Just don’t forget to keep your sunscreen on-hand, and reapply throughout the day.

Create an obstacle course

Using what you have around your home and yard combined with physical activities (jumping jacks, anyone?), create a fun obstacle course. Time each other to see who can complete the course fastest.

Take a bike ride

Explore your neighborhood or local trails on bicycle. Biking is a great activity for all ages and skill levels. Don’t forget your helmet!

Neighborhood scavenger hunt

Create a list of objects to gather or tasks that can be completed in your yard or neighborhood. Or, try a photo scavenger hunt: rather than collecting treasures, have your scavengers take a photo of the object or activity. The first to return with all their boxes checked wins!

Go to a park

Need a change of scenery to get motivated? Check out your local parks. They offer trails for running, hiking or biking, team sports, swimming, play structures and oftentimes activities for kids – all within your community.

Play a game

When you love what you do, it doesn’t feel like work. The same is true for fitness. If you choose an activity that you and your family enjoy, you won’t event realize you are achieving your fitness goals. Whether its soccer, baseball, kickball, basketball or something you make up – pick your teams and let the games begin!

Dance party!

Create a playlist of family favorite tunes, and turn up the volume!

Plant a garden

Planning and creating a garden creates a reason to go outside every day. Maintaining the garden provides an opportunity for physical activity and as an added bonus creates a sense of responsibility. Plant and cook from a vegetable garden for an extra positive impact on your family’s health.

Join a class

The best way to fit fitness into your schedule, is to literally schedule it. Find a local facility that offers family fitness classes, or sign up individually.

Sign up for a race

Many charities or organizations will host a fun run or race as a fundraiser. Find one that appeals to your family, and sign up! The approaching race date will give you the motivation to train, and most of the time there are shorter route options for different ages and fitness levels, so everyone can join in.

Use a fitness tracker

Weekly Fitness Tracker

Keeping track of your physical activity is a great way to ensure you achieve your goals for daily activity. There are several digital trackers available for purchase or use this fridge-ready template to add up your minutes. As a friendly competition, have the whole family keep track of their time. Accountability goes a long way!

Remember: 15 minutes counts. A quick driveway basketball game or bike ride around the block can make some great strides towards a healthier lifestyle, and make an impact on your child’s lifestyle as they grow.

If you have questions or concerns about physical activity for anyone in your family, make an appointment with your pediatric or primary care provider today. And then get moving!

Make An Appointment