Request an Appointment

If you are new to UC San Diego Health or are unable to schedule using MyChart and would like to see one of our physicians, please submit this form and our Physician Access Service team will contact you. Please allow up to three business days for a response to this request. Answers to all questions are required.

First Name:

Last Name:

Email Address:

Zip Code:

Daytime Contact Phone:

Preferred Method of Communication:

Phone

Email

Type of Service:

Reason for visit:

Preferred Contact Times:

Monday AM

Monday PM

Tuesday AM

Tuesday PM

Wednesday AM

Wednesday PM

Thursday AM

Thursday PM

Friday AM

Friday PM

Are you transferring care from another organization?

No transfer

Scripps

Kaiser

Sharp

Military

Out of State

Other

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