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UCLA Health New Patient Appointment Request

Please use this form only if you are a new patient. Current patients, please request an appointment at myUCLAhealth.

If you need to speak with someone immediately, please call the Physician Referral Team at (800) 825-2631 / (800) UCLA-MD1, Monday to Friday, 7 am - 7 pm.

If this is an emergency, call 911
This question requires a valid date format of MM/DD/YYYY.
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