Neurology Appointment Request - UCLA Health

If you are having a medical emergency, call 911 or go to your nearest emergency department. For urgent matters, please contact your doctor's office or find an Immediate Care location near you.

If you have seen a UCLA Neurologist in the past 3 years, click here to schedule an appointment in myUCLAhealth.

If you are interested in seeing a subspecialist, please note that a referral is required.

After you submit the form, you will receive a call within 1-2 business days (excluding weekends and holidays) from our team to assist you.

First Name *

Last Name *

Mobile Phone

Home Phone

Email Address *

Street Address *

City

State or Province

Zip or Postal Code *

Gender *

Date of Birth *

MM/DD/YYYY

Patient’s Preferred Language *

Is an interpreter needed?

Yes

Type of Insurance *

Medical Group (if applicable)

Is this your first time scheduling with a UCLA physician? *

Yes

Brief explanation of the reason for the appointment and/or diagnosis:

Do you have a referral?

Yes

What is the referring doctor's name?

Are you interested in seeing a specific doctor? If yes, please give a name:

I agree to receive communications from UCLA Health.