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El Campo Memorial Hospital

Non-Urgent Appointment Request

Non-Urgent Only
If you are experiencing Chest Pain or Shortness of Breath please proceed to the nearest Emergency Room or call 911.

Call (979) 543-5510 to SCHEDULE SAME DAY APPOINTMENTS.
* Language English     Spanish    
* Patient First Name
* Patient Last Name
* Patient Date of Birth
  Contact Person
If other than patient.
* Return Phone Number
* Best Time To Call
* Doctor
* Requested Date
* Reason for Visit
Please Provide Current Insurance Information if Available.
  Insurance Name
  Subscriber ID
  Group Number
You will be contacted to schedule your appointment within 24 hrs. Call (979) 543-5510 to SCHEDULE SAME DAY APPOINTMENTS.