If this is an emergency, please call 911 immediately.
Please complete the form below to submit a request for an appointment with a physician. After you submit a request, you will receive a call from a representative at the selected location within two business days to confirm your information and schedule the appointment. If you are a parent making a request for your child, please put your child's information in the 'Patient Information' section and your name in the 'Contact Information' section.
If you require a more immediate appointment for an illness, call (888) LUHS-888 (888-584-7888).
* required field