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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 ›

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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.

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.

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Patient Information
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Are you the patient?
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Contact Information
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What kind of scan do you need?
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X-rays do not require an appointment and are performed on a walk-in basis at UCI Medical Center in Orange, Gottschalk Medical Plaza in Irvine, UCI Health — Tustin and UCI Health — Yorba Linda.
Your Appointment Request
 

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