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To improve patient experience, we have centralized all subscriptions under our digital health brand Medzino. You will now be redirected to our brand Medzino to complete the appointment request. We are still the same team behind the service but only changing the intake process.

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Book a Specialist appointment today.

For urgent or emergent medical needs, please call 911 or visit your nearest emergency department. Our online appointment request forms are intended for non-urgent appointments only.

Please fill in the form below.

Personal details

For Dermatology visits, you're required to upload 2 high res images of the area of concern.*YesNot Applicable

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Gender at birth*MaleFemalePrefer not to say

Date of birth*

Emergency Contact Name*

Phone No*

Emergency Contact Relationship*

Name of person completing form and relationship to patient*

Reason for appointment*

Current medications and dosage*

List any medical allergies*

Primary Care Physician (Name, Phone, Address)*

Preferred Pharmacy

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Phone No

Address

City

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Zip

Appointment type *Initial consultation visitFollow-up visit

Is patient a minor ?*YesNoDo you have any current or pending legal issues or are being advised by a court judge,parole officer, or CPS to seek mental health care or assessment?*YesNoPlease select if you have ever experienced or suffered from any of the following in the past or present? (check that applies)Have you had thoughts of harming yourself?*PastCurrentlyNeverHave you had thoughts of harming others?*PastCurrentlyNeverHave you struggled with alcohol abuse?*PastCurrentlyNeverHave you struggled with substance abuse?*PastCurrentlyNever

ConsentI agree to the TeleMed2U Terms & Conditions, Telehealth Consent, Privacy Policy and Notice of Privacy Practices, and understand all of these can be accessed at any time on telemed2u.com.

Disclaimer: Self-paying patients have to pay their balance prior to their appointment.

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Contact Us

Phone:
(855) 446-8628

TeleMed2U

Call or Text: (855) 446-8628

Fax: 916-527-0770

3400 Douglas Blvd.
Suite 170
Roseville, CA 95661

Leadership & Board Careers For Providers Press Contact us

Organizations

Health Plans Health Systems Referring Providers Other Partners

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Telehealth Consent

TeleMed2U is transitioning to AdvancedMD EMR to bring you a smoother, more seamless healthcare experience! Patients-please keep an eye out for further communication about the transition.

Select the type of Specialty you need to get started.

Behavioral Health Psychiatry and Therapy

All Other Specialties e.g. Endocrinology, Dermatology etc.

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Learn more about our services

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