IS THIS URGENT? Is the patient experiencing any of these symptoms:

  • Chest pain
  • Shortness of breath
  • Severe abdominal pain
  • Stroke symptoms (sudden weakness, loss of vision, loss of balance, or severe headache)
  • Loss of consciousness
Yes No

We need additional information about these symptoms and recommend you speak with a nurse. Please call 512-346-6611 and press "4" to speak with a nurse - available 24/7.

If this is an emergency, please call 911.

Has the patient seen FILL IN BLANK in the last three years?

Yes No

Does the patient have an active MyChart account?

Yes No

Do you need a Same-Day or After Hours appointment?

Yes No

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