Request an appointment
If you are having a medical or mental health emergency, please call 911.
After submitting this form, a representative from the VCU Health Patient Appointment Center will contact you within 1 to 2 business days to assist with scheduling an in-person or virtual visit. If you would like to speak with a representative sooner, please call 800-762-6161.
If you are a provider, please fill out our patient referral form.
If you are requesting an appointment for a patient under the age of 18, please use our pediatric appointment request form.
For Massey Cancer Center, please use our request an appointment form.
*Denotes required field
What type of provider do you need to see? *
Do you have a preferred provider?
Do you have a preferred location?
Briefly describe the reason for the visit:
Patient information
First name: *
Last name: *
Date of birth (mm/dd/yyyy): *
Phone (xxx-xxx-xxxx): *
Email: *
Zip code: *
Preferred language: *
Insurance type: *