Make an Appointment

1. Please enter your name:   

2. Please enter your email address:
  (e.g:yourID@uis.edu)

3. Would you like to see

Nurse
Physician

4. Please specify the problem you would like to be seen for

Allergies Eyes/Respiratory Gynecology Immunization Cold and Flu Tuberculosis follow-up Ear, Nose and Throat Dermatology Exercise(strains/sprains) Headache Nutrition Sexual Health Travel Health SARS Others

5. Type the 3 dates and times you would like to come in

(e.g. 7/24/2003 2:40p.m. 8/10/2003 11:30a.m. 8/15/2003 1:30p.m.)

First Choice :    

Second Choice:

Third Choice :   

6. Describe some details (e.g. symptoms, how long you have it, etc.)