Request An Appointment | University of Utah Health

To request an appointment, please fill out your personal information and click on the button labeled "Submit". You will receive a response within one business day.

Neurology: 801-585-7575
Neurosurgery: 801-585-6065

What Specialty Do You Need?

First Name*

Last Name*

Date of Birth:

City

Postal Code

Email Address*

Phone Number:

Preferred Contact Method: Email
Phone

Preferred Contact Time:

Insurance

What Would You Like To Be Seen For?

Neurology or Neurosurgery?

Neurology
Neurosurgery

Applicable Imaging (Please Include Type Of Imaging And Date Obtained)

Have You Recently Done Physical Therapy For The Problem You Seek An Appointment For?

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If Yes, Then Please Explain:

Have You Recently Had Any Injections For The Problem You Seek An Appointment For?

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If Yes, Then Please Explain: