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Appointments

To schedule an appointment, either pre-register using our Online Appointment Form or Call 1-888-277-5666.

To pre-register, fill out the form below completely, including all insurance information and preferred appointment time and date, and a representative from UEC will contact you to confirm within 24 hours. While we cannot guarantee a specific date or time, we will make all efforts to do so.

*First Name:
*Last Name:
*Phone:
*E-Mail:
Address:
City:
State:
Zip Code:
*Date of Birth:
 

Insurance Information

Insured Name:
Relationship:
Employer:
Address:
 
Secondary Insurer:
Policy #:
Group #:
 

Nature of Appointment

 
 
  *Required Information