New Patient Appointment Request
Patients new to Memorial Health University Physicians (MHUP
) may use this form to request an appointment with any of our
providers or specialists
Already an MHUP patient? Request an appointment through
or call your doctor’s office directly.
To sign up for MyChart, enter the access code you received on the paperwork from your last visit. Or, call your doctor’s office to get an access code.
Do not use this form for a medical emergency. If you are experiencing an emergency, dial 911.
Required fields are marked with an *