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Request an appointment 
with a UK HealthCare physician

To request an appointment using this secure form, fill it out and click the submit button. One of our friendly schedulers will contact you within 24 hours Monday-Friday to help you set up an appointment. 

Cancel or reschedule using our cancellation form or by calling 859-257-1000 or toll free 800-333-8874.  

Your privacy is important to us, so we will never share your personal information with others.

Fields marked * are required.

First name:*
Last name:*
Primary phone number:* 000-000-0000
Alternate phone number: 000-000-0000
Email address:*
Gender:* Male Female
Date of birth:* / / (mm / dd / yyyy)
Name of physician or provider you would like to see:
Did a provider refer you? Please give us their name:
Referring provider's phone number: 000-000-0000
Referring provider's phone number (alternate): 000-000-0000
What is your reason for seeing the physician?*