Radiology 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 ›
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.
What to expect: One of our referral specialists will contact you within two business days. We recommend having your insurance information and any other pertinent information available.
An asterisk (*) indicates a required field.