De Zavala Appointment Form (Primary Care & Specialty)

Request an appointment

New patients, please fill out the form below to request an appointment at UT Health De Zavala. We will call you to confirm your appointment date and time.

Existing primary care patients can now schedule an appointment with their primary care provider using MyChart. Online scheduling is convenient and lets you schedule an appointment without calling. Simply log in to MyChart and select “Schedule an Appointment” from the menu.

If you are a current patient with one of our specialty care providers and have a MyChart account, please log into your account to select your provider and preferred appointment time. Or, call 210-450-6720 to make an appointment. If you would like help using your MyChart account, you may call 210-450-4111 for technical assistance.

If you are experiencing a medical emergency, do not use this form. Call 9-1-1 for emergency help, and then follow up with your provider.

Patient's Name*

First Name

Last Name

Date of birth*

MM/MM/YYYY

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Please enter your phone number in this format: 999-999-9999. You will not be able to submit the form without an area code.

Email*

Gender*

Female Male

Type of appointment*

*If a patient's insurance requires authorization from their primary care provider, an appointment cannot be scheduled until the referral is received.

Patient type*

First-time patient Returning patient

Reason for visit*

Preferred language*

English Spanish Other

Campaign Source

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Campaign Medium

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Campaign Term

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Campaign Content

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Campaign Name

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