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Appointment Request

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

Already a patient?

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 heart health coaching patient or making an appointment for a heart health coaching 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.

Medical emergencies

Call 911 if you are experiencing an emergency. Do not use this form.

Make an Appointment


In this Section...

Heart Health Coaching

Patient Information
Are you the patient?

Contact Information
Best time to call you

Reason for Appointment
Would you like an English- or Spanish-speaking health coach?