Appointment request

Tell us what you need, we'll find the time.

This goes straight to your campus clinic — no call centre in between. They'll get back to you to confirm a time that fits around your classes.

Patient*

Please choose new or existing patient.

Location*

Please choose your campus.

Appointment type*

Please choose an appointment type.

Legal first and last name*

Please enter your first and last name.

Date of birth*

Please enter a valid date of birth.

Student ID (optional)

Phone*

Please enter a phone number we can reach you at.

Email*

Please enter a valid email address.

Would you like us to submit an estimate to your insurance provider before your upcoming visit?*

Yes No

A pre-determination tells you what your plan covers before any treatment starts.

Please choose yes or no.

Anything we should know? (optional)

Please don't send detailed medical history here — we'll take that at your visit.

We reply from your campus clinic — no call centre.

Prefer to talk? Call your clinic.

Request sent.