eAppointment Request

Please complete the electronic form below to submit an eAppointment request to our scheduling team.

If you are experiencing a medical emergency or life-threatening circumstances, please call 911.

Appointment Information

Requested Provider

Submitted Via

Appointment Type Requested

Telemedicine Visit

New Patient

Returning Patient

Physician Referral

Have you previously been seen at the UF Orthopaedics and Sports Medicine Institute?

Reason for Appointment Request

Patient's Name

First

Middle Initial

Last

Patient Date of Birth

Your relationship to the patient

Your Name (if you are NOT the patient listed above)

First

Middle Initial

Last

E-mail Address

Contact Phone Number

Patient ZIP Code