Preferences - UCLA Health - Los Angeles, CA

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 click here to see Immediate Care locations.

Existing patients can request appointments and communicate with their care team by signing into myUCLAhealth.

Please use this form only if:

You have never been a patient at UCLA Health, OR
You have been a patient at UCLA Health but are seeking an appointment with a new doctor or within a new clinical specialty.

Note: all physicals, follow ups and medication management appointments should be directed to your current care team.

After you submit the form, a Physician Referral Representative will call you back within 1-2 business days (excluding weekends/holidays) to make an appointment. You may also speak with a representative directly at 310-825-2631, Monday – Friday, 7 am to 7 pm.

First Name *

Last Name *

Phone Number *

Alternate Phone Number

Best Time to Call

Email Address *

Zip or Postal Code *

Gender *

Date of Birth *

MM/DD/YYYY

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

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

Yes

Type of Insurance *

If you were referred by a doctor, 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.

UCLA Health Appointment Request