Request an Appointment

We are here to help you make an appointment. To begin your request, please fill out the form below and we will contact you by phone within one business day. If you submit your request on a holiday or Friday afternoon through Sunday, we will respond by the end of the next business day. If you do not hear from us within this timeframe, have questions, or prefer to make an appointment by phone, please call UCM Connect at 1-888-824-0200. We will be happy to assist you. Please note this electronic request form is not for same- or next-day appointments. If you prefer immediate assistance, please call 1-888-824-0200.

Returning patients may use MyChart to request an appointment.

Read our Notice of Privacy Practices.

For those outside the United States: Please visit our Center for International Patients for contact information.

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Patient Information
* Gender
If your provider is not listed, please call UCM Connect at 1-888-824-0200.
* Do you have a physician referral?   Don't know
Contact Information
  (Central Time Zone)
Appointment Information
Have you seen this physician before?
Have you been a patient at the University of Chicago Medicine in the past?

By submitting this form you acknowledge the risk of sending this information by email and agree not to hold the University of Chicago or the 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-patient relationship. More information regarding the confidentiality of this request can be found in our Privacy Policy.