Request an Appointment

Need Care Now?

In an Emergency

Call 911 or go to the nearest emergency room. Visit our Emergency Department.

Schedule a Visit

Depending on your needs, scheduled visits may be:

• In-person (at the clinic)
• Virtual (online or over the phone)

Option 1: Request in MyChart

If you're a current UVA patient, you can reach your clinic through MyChart.

Option 2: Schedule by Phone

New and existing patients can call 434.924.0000 to connect with a clinic.

Option 3: Submit Form Below

Complete the form below. We'll call you for any additional information to schedule your appointment and next steps. After three failed attempts to reach you, we will cancel your request.

Referrals

Are you a medical professional looking to refer your patient? Refer your patient

* required fields

Patient Information

First Name *

Middle Name

Last Name *

Prior Name

Gender

Male Female

Date of Birth *

Reason For Appointment *
Maximum 600 characters

Characters remaining: 600

Contact Information

Telephone

Primary Daytime Phone *

We will contact you at this number to help schedule the appointment.

May we leave a message? *

Yes No

Email

Email Address *

Your email will only be used to confirm that we have received your appointment request.

Email Address (confirm) *

By submitting this form, you agree to our privacy policy.