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For questions, or to speak with someone directly, please call:
1-888-824-0200

New Patients

To request an appointment, please use our secure online form. A representative will contact you within one to two business days to help you schedule an appointment.
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Current Patients

Current patients may also use MyChart to request an appointment.

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MyChart is not for medical emergencies. If you have a medical emergency, call 911.

If you need help with MyChart, call us at 1-844-442-4278.

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Please note this electronic request form is not for same- or next-day appointments. If you prefer 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.

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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

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Location

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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.

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