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Cancer Center Appointment Request
Please do not use this form to schedule a COVID-19 vaccine appointment.
For COVID-19 vaccine availability and scheduling, visit vaccine.ucihealth.org ›
Please use this form only if you are a new patient or making an appointment for a patient. If this is a medical emergency, please dial 911.
After you submit your request, a UCI Health representative will contact you by phone within one business day to assist in making an appointment.
An asterisk (*) indicates a required field.
