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Request an appointment with a
UK HealthCare provider

To request an appointment using this secure form, fill it out and click the "submit" button. We will contact you within 24 hours Monday-Friday to help you schedule an appointment.

To schedule, reschedule or cancel an appointment call 859-257-1000 or toll free 800-333-8874.

Please enter your information below. Fields marked * are required. Your privacy is important to us, so we will never share your personal information with others.

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:
Name of referring physician or provider:
Referring physician or provider's phone number(s):
What is your reason for seeing the physician?*