Telehealth Genetic Counseling Appointment Request Form

Patient Information

While based in Texas, our genetic counseling team is licensed to offer virtual consultations to patients physically located in any of the other states listed in the drop down below.
Please provide the best number to reach you at for health-related matters.

Appointment Information

Insurance Information

Accepted file types: jpg, gif, png, Max. file size: 8 MB.
Accepted file types: pdf, jpg, gif, png, Max. file size: 20 MB.
Terms for Online Appointment

The information we collect from the online form is used only for appointment scheduling purposes. Any follow up phone calls or email communications will be related to your care.

You and UT Physicians or any of its health care providers do not have a patient-provider relationship.

In addition, information provided on the website or any response to you is not and cannot be considered medical advice or treatment.

This field is for validation purposes and should be left unchanged.