Request An Appointment at CTCA

The easiest way to become a new patient at a CTCA facility is to call an Oncology Information Specialist at 1-800-615-3055. OIS representatives are available 24 hours a day, seven days a week.

If you prefer, you may begin the new patient appointment process by completing the form below. After submitting your request an Oncology Information Specialist will call you directly to collect additional information before confirming your first appointment.

A financial assessment and/or insurance verification must be performed prior to confirming an appointment. CTCA works with many major insurance carriers and your Oncology Information Specialist will work with you to verify your insurance benefits prior to scheduling your first appointment.

First Name:*

Appointment Request Form
This request form is for new patients only. If you are a returning or existing patient, please contact your OIS representative at 1-800-615-3055.

Last Name:*

Address:

City:

State:*

Postal Code:

Your Email:*

Phone:

Birth Date:

Gender:

Insurance:

Insurance Type:

First Diagnosis:

Month:

Year:

Cancer Type:*

If you would like to leave additional comments for your
Oncology Information Specialist, please type it here:

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Thank You!

Request An Appointment at CTCA