Request an Appointment

To expedite your appointment request, you will need information from your health insurance card. Or:
Use MyChart Call 800-777-8442 (toll-free)

Contact Information

This appointment is being made for…

Myself

Someone Else

Contact Name

Relationship to Patient

Email *

Phone *

When can we call you?

May we leave a message?

Patient Information

First Name *

Middle Name

Last Name *

Maiden/Former Name

if applicable

Street Address *

Zip *

City

State

Date of Birth *

Was patient born or previously seen at UI Hospitals & Clinics?

Insurance Information

Does the patient have insurance?

Yes

Insurance Company Name *

Policy or Member Number *

Policy Holder's Name *

Policy Holder's Date of Birth *

mm/dd/yyyy

Insurance customer service phone number

About Your Appointment

Preferred Physician or Specialty

What is the purpose for your request? *

Please leave blank

For emergencies call 911.

Access UIeCare anytime via computer, tablet, or smartphone. Our team of care experts provides treatment 24/7 without an appointment

Request Care

eCheck-in

MyChart now offers eCheck-in, a feature that helps you prepare for your upcoming appointment. With eCheck-in you can:

Avoid having to fill out forms in the waiting room
Update your medical history and contact information
Confirm your current insurance plan
Provide information about your current condition

For Providers Referring Patients

UI Consult

Referrals, Transfers and Consults

Local: 319-384-8008
Toll-Free: 800-322-8442
Hours: 24 hours

Refer a patient online

Providers will outline the care needs for the individual being transferred. We will confirm an appointment time within two business days.

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