New Patient Appointment Request Form

Thank You for Choosing BIDMC

We are here to assist you before, during, and after your appointment.

New Patients

Please fill out the form below if you would like to become a new patient, and a BIDMC representative will contact you during regular business hours to schedule your first appointment.

Find a Specialist New Patient Form

Current Patients

The form below is for new patients only. For current patients: Please call your physician's office or use the MyBILH Chart patient portal to schedule your appointment online.

MyBILH Chart

Looking for a Primary Care Provider (PCP)?

If you're new to BILH Primary Care, use our online appointment scheduler to set up your first primary care appointment.

Find a PCP Schedule Online

If you are experiencing a medical emergency, call 911. Please do not use this form.

First Name Last Name Email Address Phone Number Date of Birth (MM/DD/YYYY) Department

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