///New International Patient Appointment Request Form
New International Patient Appointment Request Form 2019-07-10T16:28:06-05:00

New International Patient Appointment Request Form

Please do not schedule travel or come to UAMS until an appointment is confirmed by the International Patient Services Department.

The mission of International Patient Services is to facilitate a prompt appointment process without delays and arrange assistance based on the patient’s specific needs. Please provide the following information to help our department prepare for your arrival.

All email correspondence and phone contacts are answered in English. If you prefer to speak with a person using your native language, please indicate the desire to have interpreting assistance below.

Please fill in all fields below with as much detail as possible. We will call or email you if we have any questions.

  • Patient Information

  • Please include the country code and/or area code where applicable.
  • Please include the country code and/or area code where applicable.
  • DD / MM / YYYY
  • Your Information

    If you are submitting this form on behalf of another person, please fill out the section below.
  • Please include the country code and/or area code where applicable.
  • Please include the country code and/or area code where applicable.

Department of International Patient Services

Tel: 501-686-7133

Fax: 501-526-6554

InternationalPatientServices@uams.edu