Making An Appointment Online

Registered nurse counselors can help you assess the nature of your health problem or concern and direct you to the appropriate VCU Health System physician and services. They can also help you schedule an appointment.

To make an appointment, please complete the form below and be sure to let us know how you would like to be contacted. A VCU Health System registered nurse will respond within two business days. You may also call our Information and Referral Center at (800) 762-6161, on weekdays from 8 a.m. to 5 p.m., to speak with someone immediately.

Please read Our Privacy Statement.

Patient Name
Home Address
City
State
Zip Code
Country
Daytime Phone Number
E-mail Address
Date of Birth
Gender
Health Insurance Plan

Health Insurance Type
Your Name
(if different from patient)
E-mail Address
Daytime Phone Number

Specialty Preference

Procedure Preference
Location Preference
Reason for Referral


Would you like us to schedule the appointment?
 Yes No

If yes, please specify your preferences:

Day of the Week

Time of Day

When

   

Additional Information:

   

 

* * Please note that we cannot offer medical advice or diagnosis by e-mail, telephone or mail. If you have a health-related question or suspect that you have a health problem, you should consult your physician or make an appointment with a VCU Health System physician.
Date Last Modified: June 12, 2001
Questions or Comments? Contact Us
 401 North 12th Street
Richmond, VA 23298
VCU Health System Information: (804) 828-9000
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