ALS Neuromuscular Center Appointment Request

Please do not use this form to schedule a COVID-19 vaccine appointment. For COVID-19 vaccine availability and scheduling, visit vaccine.ucihealth.org ›

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If you are an existing patient, please log into the patient portal to submit an appointment request ›

Please use this form only if you are a new patient or making an appointment for a patient. If this is a medical emergency, please dial 911.

An asterisk (*) indicates a required field.

After you submit your request, a UCI Health representative will contact you by phone within two business days to assist in making an appointment.