Carolinas HealthCare System
Appointment requests will be responded to in one business day. This form is not for urgent appointments or for appointments you need today. If you are having an emergency, call 911 or go to your nearest emergency room. If you need care now but your concern is not emergent, visit one of our urgent care offices. Many specialty appointments must be made directly with physician offices.

If you already have a Carolinas HealthCare physician and have access to MyCarolinas, you can go directly book your appointment there.

* Indicates required information
Patient Information
First Name * 
Last Name * 
Date of Birth *   (mm/dd/yyyy format)
Address *
City *
State/Province *
Zip Code/Postal Code *
Email Address *
Preferred Phone Number *
Insurance Information * 
Please include insurance name and group number
Name of Doctor, if known 
Best times and/or dates for your appointment 
Confirmation * Tell us how you want to receive appointment confirmation.
Name of Requesting Individual 
If you are making this appointment for someone other than yourself.
Reason for Appointment *
Need additional appointment(s)? 
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