Secure Patient Portal

Request an Appointment

For current University Urology patients. Tell us what you need and our team will call you to confirm a time.

New to University Urology? Click here for a new patient request →

Your Information

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address *

Reason for Visit

Primary Concern *

⚕ A few quick questions to help us prioritize your care

What would you like to discuss at this visit? *

Your Preferences

Established Provider *

Location Preference

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🔒 This form is transmitted over an encrypted (HTTPS) connection. Your information is protected health information and will only be used to schedule your appointment. Privacy Policy

✅

Request Received

Thank you — your appointment request has been received. Our front office team will be in touch to confirm your appointment.

If this is a medical emergency, please call 911 or go to your nearest emergency room.

Your confirmation number:

Please save this number for your records.

Questions? Call us at 865-305-9254