TELEHEALTH COVID-19 ASSESSMENT REGISTRATION

Please complete the form below to register online for your Telehealth Covid-19 Assessment through UMC.

THESE APPOINTMENTS ARE FOR COVID-RELATED CONCERNS ONLY. FOR NON-COVID RELATED ISSUES CALL 702-383-2273

PATIENT INFORMATION
Last Name: * First Name: *
Phone #: * Date of Birth: * MM/DD/YYYY
Employee ID#: Employer Name:
INFORMED CONSENT

Please read the "Informed Consent for COVID-19 Diagnostic Testing" document. Clicking this link will open the document in a separate browser tab.

Acknowledgment

AUTHORIZATION AND CONSENT FOR TELEHEALTH SERVICES

Please read the "Authorization and Consent for Telehealth Services" document. Clicking this link will open the document in a separate browser tab.

Acknowledgment

For assistance with UMConnect or the MyChart app, please call 702-789-5160.

To speak with a UMC representative, please call 702-383-1800.

To submit this form and continue the scheduling process, please click the "Schedule your Telehealth COVID-19 Assessment"
button below.