Request an Appointment | Contact Us | About Us | University of Pennsylvania Health System

If you have symptoms of an urgent nature, please call your doctor or go to the nearest emergency room immediately.

This is a secure form, and the information you provide will enable us to assist you as efficiently as possible. Requests are received by the Penn Medicine Contact Center. A representative from the contact center will contact you within 1 business day to help you schedule an appointment.

For faster assistance, please call 800-789-PENN (7366).

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First Name
Last Name
Date of Birth
( mm/dd/yyyy )
Daytime Phone
( ### - ### - #### )
A Penn Medicine Contact Center Representative will call the patient/contact person between 8:30am–5:00pm EST, Monday–Friday
E-mail
Preferred Physician or Service
Reason for Request
NOTE: With this form, you are submitting a request for an appointment. You are not scheduling an appointment. A representative from the Penn Medicine Contact Center will contact you to help you schedule an appointment.

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Request an Appointment at Penn Medicine

Psychiatry/Behavioral Health