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To request information, please fill out the form below. If you have any other questions or would like to make an appointment by phone, please call UCM Connect at 1-888-824-0200.

Returning patients may use MyChart to view their medical information, request prescription refills, review results, request appointments and more.

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Information Request

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.