Request an Appointment

To speak to someone directly, please call 1-888-824-0200. If you have symptoms of an urgent nature, please call your doctor or go to the emergency room immediately.

Indicates Required Field

Patient's First Name Please enter a first name

Patient's Last Name Please enter a last name

Patient's Date of Birth

Gender Please select a gender

Email Address

Phone Number Please enter your phone number

Zip Code Please enter a valid zip code

Medical Information

Specialty

Location

Doctor

Reason For Appointment

By submitting this form you acknowledge the risk of sending this information by email and agree not to hold the University of Chicago or University of Chicago Medical Center liable for any damages you may incur as a result of the transfer or use of this information. The use or transmittal of this form does not create a physician-contact relationship. More information regarding the confidentiality of this request can be found in our Privacy Policy.

Clear Form

See All Patient & Visitor Information

See All Healthcare Professionals Information

Research & Clinical Trials

Medical Information

I'd Like to

See All Patient & Visitor Information

See All Healthcare Professionals Information

Research & Clinical Trials

Request an Appointment

Medical Information

I'd Like to

See All Patient & Visitor Information

Schedule an Appointment

Patient Portal

See All Healthcare Professionals Information

Careers

Research & Clinical Trials

Find a Clinical Trial