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Appointment Request Form for International Patients

Thank you for your interest in Rush University Medical Center. We are happy to assist you. If you live outside of the United States and would like more information on seeing a physician at Rush, please submit this form. After you submit this request, a member of the International Health Services Team will respond to you by email within two business days.

New Patients

So that we can arrange an appointment with the appropriate physician, you will need to provide us with confidential health information. We will use this information only to help us respond to your request. Before filling out this request, please read our Notice of Privacy Practices for more information on Rush’s commitment to maintaining your privacy.

Please do not use this form under the following circumstances:

  • If you are currently living in the United States and would like an appointment with a physician at Rush, please fill out this appointment request form instead.
  • To view the clinical trials available at Rush, please visit the Clinical Trials home page.
  • For general inquiries about Rush or physicians at Rush, please Contact Rush.

We have put in place appropriate physical, electronic and administrative procedures to safeguard and secure the information we collect from you. The information you transmit in your request will be encrypted during transmission to Rush. All mail correspondence will be encrypted, and you will need to log into a secure portal to retrieve your messages.

Thank you,
International Health Services


Patient Information

Contact Information

  1. -
    Country Code - Local Number

Appointment Information

Additional Information To Expedite Your Request