July 17, 2018     80.0F   26.7C   
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Miller School of Medicine at the University of Miami
   
   

 

Make an Appointment >>

The University of Miami Medical Group Physician Referral Office offers several ways to make an appointment.

Appointments can be made by calling the referral office at 305-243-5757 or toll-free at 800-432-0191 Monday through Friday from 7:30 a.m. to 5:30 p.m. EST. The secure Appointment Form allows appointments to be made online, any time. This secure form uses SSL technology to ensure the privacy of the personal information that you are submitting.

To use the form, please enter your information into the boxes below and click submit.

Thank you for choosing the University of Miami School of Medicine.

Please Note: If you are experiencing symptoms that are urgent in nature please contact your primary care physician or your nearest urgent care facility.

Patient Information


First Name *

Last Name *

SSN

Date of Birth *
Gender: Male Female  



Street Address *

  
City *
  
State 
*  
  
ZIP *

Country
*

Daytime Phone (w/ Area Code) *

Evening Phone (w/ Area Code)

Fax (w/ Area Code)

Email Address *

Appointment Information


Type of Service Requested

Specify if Other
  
If you know, select a department, otherwise leave blank

Specify if Other

Specify Symptoms *

Desired Date for Appointment *

Name of Requested Physician

Primary Care Physician Information


Name of Primary Care Physician (PCP)


PCP Street Address
  
PCP City
  
PCP State
  
PCP ZIP

PCP Country

Office Phone (w/ Area Code)

Office Fax (w/ Area Code)
Are you currently under treatment? Yes No

If Yes, please specify what type of treatment

Insurance Information

You will be contacted in order to review insurance coverage and obtain additional demographic information. Medical and financial eligibility need to be established prior to confirming an appointment. To expedite this verification, you may provide us with the following optional information.


Insurer

Insurance Number / Policy / Member ID

Customer Service Phone Number (w/ Area Code)
   

If you would like to leave a further message for the physician referral office, please type it here.

Information collected from this website or provided on any form you have submitted through the website is used only in conjunction with an expressed interest by the User in obtaining additional information about the University of Miami’s physician practice or services. It does not create any type of relationship between the individual providing the information and the University of Miami or any of its physicians. This information is not considered Protected Health Information (PHI) and will be used to contact you because you have requested that you be contacted. In addition, information provided on the website or in any response to you is not and cannot be considered medical advice or treatment. The University of Miami will not be liable for and you will release and hold them harmless from any claims and/or any direct, indirect, consequential, special, exemplary, or other damages arising therefrom. Please consult with your doctor for medical advice or treatment for any condition you may have. If you are experiencing a medical emergency, call 911 and/or go to the nearest emergency room.

I have read and agree to the above. *


All referral forms will receive a phone response within one business day. The Physician Referral Office is open Monday through Friday from 7:30 a.m. to 5:30 p.m. Eastern Time. You can reach us at 305-243-5757 or 800-432-0191.

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