Request an Appointment

We invite you to use this secure online form to request an appointment at UConn Health. After receipt of your completed form, a UConn Health representative will contact you within the next two business days.

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* Legal First Name:
* Last Name:
* Daytime Phone:
Best Time to Contact:
* Type of Appointment:
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* Reason for Appointment:
* Address Line 1:
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* City:
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* Date of Birth (MM/DD/YYYY):
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For greater security, the information you provide on this form will be encrypted during transmission to us. Please read our privacy policy if you have any questions about how we handle the information you provide. If you prefer to discuss your request over the telephone, please call 860-679-7692 or 800-535-6232.

    

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Contact Information

If you have any questions or would like help with classes, services, or research studies offered at UConn Health, call us at 800-535-6232 or 860-679-7692, or email us at ccda@up.uchc.edu.