Skip to main content

UTHealth Epilepsy – Same Day Referral

Thank you for contacting us. Please answer these quick questions, and we will get your referral passed on to a Texas Comprehensive Epilepsy Program representative immediately.

Patient Information

Please note: that same day appointments can be made if this request is received before noon by our staff. Pressing the "Submit" button on this form after noon might result in the clinic scheduling you for the next business day.
Patient's name:(Required)
MM slash DD slash YYYY
(Please leave blank if you don't want to be called)
If you have health insurance, please list your insurance provider and policy type (if you know them) to help us quickly verify that we accept your plan.

Terms for Online Appointment Request

The information we collect from this website is used only for obtaining information about you for scheduling purposes.

You and UTHealth Neurosciences do not yet have a patient-provider relationship. The information we collect will be used to contact you because you have requested that we contact you.

In addition, information provided on the website or in any response to you is not and cannot be considered medical advice or treatment.

Protected by reCAPTCHA