Please do not use this form to schedule a COVID-19 vaccine appointment. For COVID-19 vaccine availability and scheduling, visit vaccine.ucihealth.org ›
Please use this form only if you are a new patient or making an appointment for a patient.
After you submit your request, a UCI Health representative will contact you by phone within one business day to assist in making an appointment.
Call 911 if you are experiencing an emergency. Do not use this form.