Make an Appointment at UTMB Health

Online Appointment Request Formfor New Patients or patients without access to MyChart

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Please review these important tips before getting started:

  • This service is not intended for urgent or emergency situations.
  • To reschedule or cancel an existing appointment, please use our Appointment Reschedule Request Form or MyChart.
  • Please make only one appointment request per form submission.
  • For Behavioral Health services in Psychiatry, please call (409) 772-0770 or 1 (800) 917-8906 ext. 20770.
  • Are you a current patient?
    Save time and effort by using MyChart to request your appointment.

For your security and privacy, your information will not be saved if you browse away from this page. If you have questions about this form or need assistance, please contact the Access Center.

Patient Information

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Contact Information

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Insurance Information

Primary Health Insurance Type
Referral Notice: Some health plans require a Primary Care Physician's (PCP) referral to reimburse for specialty care services. You may need to contact your PCP for authorization.
**No Insurance or Self Pay: Please select 'No Insurance or Self Pay' in both the insurance type and name, and please mark N/A on the following fields. Please read about our policies and practices
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Appointment Information

Do you have a particular physician that you would like to see?
Have you seen this physician before?
Have you ever had an appointment at UTMB?
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Time Preference

You should have a response within two business days. For additional questions about your appointment, please call the UTMB Access Center at 1-800-917-8906.

How did you hear about us?

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