Thank you for your interest in UCLA Health! 
 
Please complete this form if you are inquiring about services at UCLA Health for an international patient OR if the patient has international medical insurance.

If you are a domestic patient - you live or work primarily in the U.S. and do not have international medical insurance - please contact the UCLA clinic directly at 1-800-825-2631 or complete the online form for domestic patients here. 

Complete this form for international patients only once.